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APPLICATION FOR SANITATION PERMIT Permit No. .c�._: _ <br /> i� (Complete in Duplicate) �7 <br /> Date Issued _ <br /> Ap /des)c <br /> plication is ereby made to the San Joaquin Local Health District for a permit to construct and install the work herein ribd_ ed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS ANDLOCA 10tj ---- -------P". •C!%r <br /> ---------------------------------------------- ------------------------ - <br /> Owner's Name -� es7� <br /> ---- Phon _ "- <br /> Address ------- <br /> r� ----------------- --- - -----•--------------------------------"--.-----q------�--------------------- <br /> Contractor's Name ___ _______V--_�-t Fr � ---�-- ,• - ----------------------------------------- Phone L 2 <br /> 4 <br /> --- ----------- <br /> Installation will serve: Residence Ej-"Apartment House ❑ i m <br /> 'Trailer Cofut"❑ Mo <br /> te1�❑ Other <br /> , <br /> Number of living units: __ Number of bedrooms Number ofbaths__�__ Lot- ------------------------------- <br /> 1 <br /> Water Supply: Public system Community system ❑ Private-n Dep+�;to Wier Table-3/?_fTI \ <br /> Character of soil to aldepth of 3 feet: Sand ❑ Gravel ❑ Sandy-Lpam [j+ ClaykLoam 0 Clay El' Adobe B-_-Hardpan ❑ ` <br /> Previous Application Made: Yes ❑ No R"-' New Construction. Yes ❑ No f 4 � <br /> TYPE OF-11NISTALLATION}ANDDS°PECIFICATIONS: <br /> I 1 I <br /> !(No septic tank or cesspool permitted if public sewer is available within 200 fee , <br /> Septic Tan�:'� ! Distance from nearest well-,---------- Distance from``foundat'ion�______'_._-t c_Material_____.:______•____._-______._ <br /> 1 rt . # �_ __ rY Capacity <br /> Dis❑osal Field:,' D tanc�e f Omar e est w Il_______ __ ____D stance from oundat� pUld deep+h � nce to nearest lot. <br /> y <br /> p # .liner <br /> ❑ ,< , Number of fines___ �i_--1---#--------------------Length of each,line------ - i----- !�' Width of ire!A--- ------------------------ <br /> f. I <br /> f� Type o filter materiah_-� ___Depth of filter er-iaL_ '_'�_ � {Total Yfength------------------------------------- <br /> --------------- . . - <br /> Seepage Pit: Distance to pits <br /> well- Distance fromfou dation___._ : �_l r D,staA to nearest lot line..��__d. <br /> Number of its-------- __-„__Linin material d'%__ _ ---Size: DiamateT _ -__--.Depth.__.. - <br /> - ------------ <br /> r I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_____.-_-_ Lin materia!__.___-._____.__,__:_._______.__.___. <br /> ❑ Size- Diameter Depth -- ----- ---!�![_Liqui' Capacity---------­-----------------gals. <br /> Privy: Distance from nearest well_____..__,._ __.._Distance from neae building <br /> E -- g------------------------------- <br /> ❑ Dsstance to nearest lot li - -- --------------- - ---------------- ----------------------- ------------------------------------------- <br /> I <br /> Remodeling and/or repairing (describe):------- -------------------------------- -----------------------------------------II <br /> t-- _ <br /> ---------• -------------- -- ------------•- <br /> ----------•---------------------------- -- <br /> ! hereby certify + - --------------------••--------•----------. ----------- ---------------------------------------- ---------------------------------- - <br /> y y hat I have pr�epar'ed thiY application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rulet,Iand regulations of the San Joa uin Local Health Distri�. <br /> r�• _ �-----� - -=- ------ •--- --- :- ---- , <br /> (Signed) <br /> fp (03r and/or Contractor) <br /> By:. _` k------------------------------------�--"----- r-------------(T tle)--- <br /> (Pio+ plan;showing size of lot, location of system in relation to wells, buildings;Jetc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B _ 1 ATE_s_ <br /> -------------------------------------- <br /> REVIEWED BY ---------------- --- -------------------------- ATE___ ,aA -------------------------•------------------- <br /> BUILDING <br /> -•------- y� <br /> PERMIT ISSUED------------------------------ - DATE_._ �� <br /> t ----- <br /> Altera+ions and/or recommendations___________________ •-..-. K�..• -- �- __j i <br /> -------------------------------------------------------- <br /> ------------------------------------------------ <br /> -------------------------•-----'------------------••----------------- --------------- <br /> ------------------------------------- ---------- -I. <br /> ------------------------------------'--------------------------I-------- <br /> --------------------------------------------------------------------------- <br /> ------------ <br /> FINAL INSPECTION"BY`".y.,”.f� , '.'t,"'' �. ---------- �, Date----. / �I .-S`�-'- "" - -^.. . <br /> SAIV JOAQUIN"LOC4L HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Sheet <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> ES-9-2M 10-52 Revised W-2100 <br />