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FOR <br /> OFFS E: <br /> --APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----- ---------- <br /> -------10- -------------------- <br /> ------------------4-L - ------------- (Complete in Duplicate) Date Issued ....OkA t, <br /> --------------------------- ------------------------- I This Permit Expires 1 Year From Date Issued <br /> Applica-t-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work FAn de crib <br /> This application is made in complian A County Ordinance No. 549. <br /> ith County <br /> N <br /> JOB ADDRESS AND OC TIO ----- ...... ----------------- ---- ----- ------------•- <br /> -----------*-------------------- --------C"J <br /> Owner-'s Name_... .......... 1-Ictek,-----------_------------- ...... ------I----------------- P h o n e 7------ <br /> Address........................... --------------------------------------------------------------------------------- <br /> --------------- <br /> .t...... . .....0............................ Phon4e.k-_3.g4._/... <br /> Contractor's Name........DAL . ... ----------- > <br /> Installation will serve: Residence F] Apartment House E] Commercial 0 Trailer Court 0 Motel 0 Other 2g C440141 <br /> . . <br /> Number of living units: A----- Number of bedrooms -_I_____ Number of,baths .I..__.. Lot size ...4-P4.0.............................. <br /> We I ter"Supply: .Public 1-system [] Community system [] Private ;K Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam E] Clay [] Adobe 2( Hardpan C] <br /> Previous Application Made: (If yes,date____________________) No a New Construction: Yes 0 No [] FHA/VA: Yes E] No E3 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation....................Material................................................. <br /> F] No. of compartments--------------------------Size...............................Liquid clepth-----------_-------------Capacity---_------------------ <br /> Disposal Field: Distance from nearest well--------_-------Distance from foundation....................Distance to nearest lot line..__............. <br /> ❑ Number of lines___________________________________Length of each line------------------------------Width of french------------------------------------ <br /> Type of filter material------------_----------Depth of filter material-----------------------Total length........................................... <br /> Seepage Pit: Distance to nearest well--aOD.........Distance f f ndation...../0-.It_.Distarice to nearest lot line..41 f <br /> '2...... <br /> x Number opits---07'4-1C-____._.Lining material.___lSize: Diameter..__,.;�4__r1-------Depth---/ ..................... <br /> .--- MT-- _ <br /> Cesspool: Distance from nearest well_------_------Distance from foundation--------------------Lining material...................................... <br /> El Size: Diameter--------_--- ---------_--------_--Depth----------------------------------------------------Liquid Capacity-------•--•-...............gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building._.---__-__-_--_-___-_-__--_________--.--. <br /> ❑ <br /> uilding_--------------------------------------- <br /> r­1 Distance to nearest lot line---------- ----------------------- -------------------­------ .......................... -----------------­------------------- <br /> Rem ctling/pnVor repairing (*Fribe): .............................. <br /> 441Wt A---- ------- .........................................................----------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law red rules and regulations of the San Joaquin Local He District. <br /> (Signed)........... ---------- ---------(.1;------------------------------------(Owner and/or Contractor) <br /> -­ -- - --- ------ <br /> BY:-------------------------- ----------------------------..................... ------(Title)--------I------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system n relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_';J;_�-'--- -- ....................................................... DATE.......... �/-------------- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE--------- ........................................ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:-------------------------------------------................................................................................................................... <br /> ------------------------------------i�.......................C'_Y. ------ - <br /> --- <br /> -- - ---------- -------- ----i ...................................................... <br /> ......................... <br /> -1Q;7e ---- -- ------------------- <br /> .1................................................................ ... <br /> ---- -------------------------------------------------------------- <br /> -------------- '�v----­------------ -------------- ----------------------------------------- - ................. --- <br /> -------------------------­----------­---------- ------------------------------------- <br /> -------------- - --------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION B ---- -- - ----- ----------- Date----5_zl.' y-------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES-9 REVISED B-59 F.P.CD.2M 6.60 <br />