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Permit No <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued <br /> .'011.mApplicafion is hereby.made.to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> ti 'lis application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS ANDWCA IONY----- - ----- ---------- -------------------------- 1"-- ---------- <br /> Owner's Name----'-' --- ----- -- ----- ---A ---------------- Phone <br /> Address_.. --------I-------------------------------------------------------- <br /> Contractor's Name-------------- -- - ----------------------------------------------------------------------------------------------------------- Phone---------------- <br /> f <br /> Installation <br /> hone----------------Installation will serve: Residence 0 Apartment House [-] Commercial)X Trailer' Court [-] Motel 0 Other E] <br /> Number of living units:--eP__ Number of bedrooms 61-_ Number of baths __._t__ Lot size ---- /�,�------------------------ <br /> Water Supply. Public system El'- Community systerri-El" Priv'ate)X -Depth to Water Tab]-/-/-e ft. <br /> I rP7------- <br /> Character of soil to a depth of 3-feet: Sand E] Gravel 0 Sandy Loam E] Clay Loam [:] Clay 0 Adobe)K Hardpan 0 <br /> Previous Application Made: Yes [] NoA' New Construction: YesX No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is availeb[e within 200 feet.) <br /> 4epf,k,T n k Distance from nearest well-----------------Distance from foundation--------------------Material------------------ -- <br /> ----------------------- --- <br /> le P <br /> n <br /> No. of compa; rfments---------------------------Size---------------------------- Liquid depth--------- ------ ---------Capacity-------------- -------- <br /> ti <br /> osa old: Distance from nearest well-------------------Distance from foundation--------------------Distance to nearest lot line_.______.___..._. <br /> Number <br /> ine----------------- <br /> Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- <br /> Type of filter material____.__ ------ -Depth of filter material-------------------- --Total length__-___________________---------------- <br /> Seepage Pit: Distance to nearest well--- - -- ---- -------Distance ' ndafion--------6�1________.Distance to nearest lot line___!_67--------- <br /> Number.of pits----1)--------------- ining materiae_..Size: Diameter__"�Fe I----------D e p f h ............... <br /> sspooL Distance from nearest well--------- ------Distance from foundation--------------------Lining material-----_.______________________._____- � <br /> < ❑ Size: <br /> aterial-------------------------------------- <br /> Size: DiamOer------- ------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. <br /> *%*rivy: Dista�'cejrorn nearest'well---------- ---------------------------------Distance from nearest building=------------ ---------------- <br /> F-1 Dis+ance.to nearest lot line______________1---------------------------------- -------------------- ----------------- ----------- <br /> -------------...... <br /> 4------ --- -I <br /> Remoderh and/or repairing ----------- <br /> - ----------- - •-------------_-------------- ­-­------ ------------- <br /> ------- --------------------------------------------------------------------/-------------- <br /> ----------------- <br /> ----------------- ----------I---------- ------------------------------------------------------------------ ----------------------- <br /> T <br /> ....... -------------------------- ---------------------------------7�------------------------------------------------------------------------- ------ <br /> fI hereby cerfi that I have prepar4'd fhis,applicafion and-that the work-will be done in accordance with San Joaquin County <br /> ordinances, Sf aws, a rules and'regulations of the San Joaquin Local Health District. <br /> (Signed)--------- ----- ------- ------- ---- -- <br /> --------------------------------------------------------------------------------------------- (Owner an <br /> /or Contractor) <br /> By:------------- 4e�,x--- --------------------------------------------------------------------------------------I-------(Title --------- <br /> 7, ).7-� ------ -------------- <br /> (Plot plan, showing Zze of lot, location of system in relation to wells, buildings, etc., can be placed on rev <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- k <br /> . ---J\---------- --- ---- ---- ----------•--------- ----------------------------------- D AT <br /> ---- <br /> REVIEWED BY'------- ---------- ------ - -------------------------------------------------------------------------- ---------- DATE__ K ------------7------------------------- <br /> -- <br /> ------------- <br /> BUILD NG`PERMIT ISSUED---------- -- _ <br /> AlferaflInspnd/crr�conne dations:_.._._- - - -------- - -------------- <br /> - <br /> - <br /> -- -------------- ---- -- ------- -- -- --- ------------------------- ....... ------ <br /> A <br /> -------- ------ ------ ------- --- ------ <br /> --- <br /> ---- ---- ---- ---- - ---------- ------------- - - --- ---------- <br /> FINAL INSPEC. ION-B = = tr Date-----+ ---- --------------------------------------------- <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American Sfreef 300 West Oak'Streat 132 Sycamore Street 914 North "C" Streef <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />