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4-M 1 APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) SCANNED---/�M <br /> A <br /> Tpp"cation is hereby made to the San Joaquin Local Health District for a permit to�G����N4hA���ha����+l�-�.�i� <br /> nsiuct and install thhei deibd. <br /> 's application is made in compliance with County Ordinance No. 549. pt <br /> JOB ADDRESS 10 <br /> �T TION.. .... . .......;------ __ ------------------------------------------ <br /> Owner's <br /> -------------------- ­­--- ------ <br /> Owner's Name---- ... ......... ... ---I-' ...... . -- ------------------ -- ---- -- ........ Phone------------------............. <br /> �;_L. L........... . . ...... ........... <br /> Address-----------*-------------i��----------- - <br /> Contractor's Name--- 4 -------- 1.--- -------- ----------- ....... -- ------------ ---------- --- ---------- Phone.---------------------------------- <br /> Installation will same: Residence Apartment House E] Commercial E] Trailer Court L] Motel [] Other ❑ <br /> Number of living units: /Number of bedrooms x <br /> -----------I <br /> Number of baths Lot size AIM-9- - .0 <br /> Water Supply: Public system ZC'ommunity system E] Private 0 Depth to Water Table . ----- <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [:] Sandy Loam Clay Loam E] Clay El Adobe ff' Hardpan E] <br /> Previous Application Made: Yes E] No 3"" New Construction: Yes Loam <br /> E] FHA/VA: Yes 5?"11\lo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet) <br /> Se nk: Distance from nearest well---- -Distance from foundation-/ `t�laterial_.6_ <br /> PL?1�1 No. of compartments...__ . .. ...... ize------------ --- ----------Liquid �Iep}h----- ..........66.�pacityv -jD- <br /> -4� _qL <br /> Dis Field: Distance from nearest well Distance from foundaf ionJ&---�A�W_Disfarce to nearest lot line.,05---rku.-.Kj- <br /> Number of lines.._-__--- ------ ----.__._.._.Length of each IineZ_0.A73/�­Z!3,_'7__3---Width of trench---------- <br /> Type of filter maferi !4Vte_K—Depth of filter material...._ ... ......Total length_.._._..._____- ------------- <br /> Seepage Pit: Distance to nearest well._.. ------__ - Distance from foundation-----------------...Distance to nearest lot line______....___. <br /> Number of pits..... --Lining material_ - - . ......Size: Diameter------------------- ---Depth ------------------------------ <br /> Cesspool: Distance from nearest well ------ Distance from foundation _ _-------Lining material . ------------_._------------- <br /> 171 Size: Diameter--------- -- ------- - Depth-__..-- --- ------------ - _-- - --------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well__.-._- -- ------------ . -Distance from nearest building ----------------------------------- <br /> F-I Distance to nearest lot line ---- -- <br /> Remod*g b <br /> ' /or repairi scribe):._. ---- ------- <br /> d/or( C,t�o_ ----------------------------------- --------------- -------------------------------------------------- <br /> :?kA.-V----Yew-_-------__---_-_-- ---------------------------------- ------------------ - --------------------------- ------------------- --------------_--------- ---------------- <br /> ------ - ---------------------------------------------------- ------------------------------ --- --- ---------- ---------I---------------------------- - ---- --------------------- ------ -- ------------------ <br /> ----------------------------------- ------------------------------- ---------- - - ---------------------------- - --------I--------------- -- ------ -------- - -------------- -------- - - ----------- <br /> I hereby ce ffy that 11 have prepar 11�lhis app'lleation and that the work will be done in accordance with San Joaquin County <br /> ordinances,ince$, a s nd rulesand Ce9l+sations of the.san Joaqym Local Health District. <br /> --- ---------- <br /> -- ----------- .(Owner and/or Contractor) <br /> By:---------_--------------------- --------------- .....- - - - - <br /> -- ---(Title) .. ...... -- ------ -- - ----- <br /> (Plot plan, showing size of lot, location of system in relation to walk, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ --------- ------------ ----- ------------------ DATE:----------- -- ----------------_----------- <br /> REVIEWED BY ------------------ --- ---- <br /> ------ DATE <br /> V---- ----------------- ---------------------------- <br /> ------------- ---- - -------------------­--- DATE--------Q <br /> ------------------------------------------ ----_------------------------------------------------------............ <br /> Alterations and/or recommendations: <br /> BUILDING PERMIT ISSUED------------------ ----- - ----- <br /> ...........­ -------------------- -------------------------------- <br /> ----------- <br /> -----_----------------_---------------- --- <br /> --------------------------------------------------7--- ---------------------------------------------------------------------- ----------------------_-----------1---------------------------_-------------- <br /> ------------ -- ----------------- - - --- 7-- --------------- ----- ------------------------------------------------------­-------- ---------------- --------------- <br /> _--------------- _ - - - -------------------- ---- ------ --- -------------- -- ---------------------------------------------------------- <br /> FINAL INSPEC LION BY:.. - - -----___ _ ---F <br /> Date..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814,Norfh "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revises 1.57 FRCO. <br />