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y <br /> 1W7 <br /> ,� 6 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ... ................ <br /> (Complete in Duplicate) V <br /> �Z� Date Issuedov' 7 <br /> on ishereb e <br /> Ap y madto the San Joaquin..Local Health District for a permit to construct and_install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRES " NSD, i� TVW <br /> _5�-Al z-- - --------------_-_----. •---•------•. ----f... f <br /> Owner's Name.. .L.!..I../F - -•-- ------ ------------------------------------------------•- -------------­- .. --- ------ Phone__114 Llk11--E ....... <br /> Address....C�` _.G�:-�- -----•-- -----=-=-------- -- ------- - ....................................................................... ----••--- .. <br /> Contractor's Name.... • -------------------------------------- - ------ Phone---------••-. ... .. <br /> Installation will serve: Residencle Apartment House ❑ Commercial ❑ Trailer Court ❑/Motel ❑ Other ❑ <br /> Number of living units: _•f-_:- Number of bedrooms _ _ Number o baths -1.._. Lot size --- _____ --------------- <br /> Water Supply: Public system F71Community system fl Private Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand P Gravel ❑ Sandy Loam Clay Loam ❑ Clay E) Adobe�ardpan 0 <br /> Previous Application Made: Yes ❑ No New Construction: Yes [ No'El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic ank: Distance from nearest well ....Distanc fro found lion-.--.%.A d Mate i _l 1 __.: <br /> P ;;��yy ,f� <br /> No. of compartments----------I--_ --._--Size---3..X_-7___X.___-_--Liquid depth.....--_7..............Ce pacify.....Qri��. _a <br /> Dispos Field Distance from nearestll � Distance from foundati©rl © a rDistance to nearest I line, w.__. <br /> Number of lines----------- Length__----_____- of each line 'J___ 1. Width of trench <br /> Type of filter material_WK 10KDepth of filter material------Ig!........Total length............. ,1_D f ...........:. <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 /> ❑ Sizes Diameter---- . --- -- -------------------Depth....................................................Liquid Capacity............... ......----.gals. <br /> Privy Distance from nearest well-------------------------------------------------Distance from nearest building..........................................- <br /> ❑ Distance to nearest lot line--------... ------••••-_--------••••-•_------ ----•---- -----•----•--------------------------------------•-------•------------ ------- <br /> Remodeling and/or repairing (describe)------ ------- --•-- ---------------------- ----- ----- -- --- -------- -•---•--------------- •------------------ <br /> - ------- ---- - ........................_•­--------------------------------------------------------- ------- ----•• •-•---. ---•---• ..---• . . •• •----- .------- <br /> hereb certify*0 ( have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, , and rules pd regulations of the San Joaquin Local Health District. <br /> Signed) ' ". _ Owner and/or Contractor <br /> By - - { .............. •-------------------------------- ----------------- -(Title)_.....................------------............................. <br /> (Plot plan,showing size of lot, location of system in relation to wells,buildings, etc., can be placed on reverse side). <br /> EP RTMEN SE ONLY <br /> APPLICATION ACCEPTED BY ----- DATE Z,�„... <br /> REVIEWED BY. -------------•-- ...•---• -----••• •-•-•••• - DATE. <br /> BUILDINC-jPERMIT ISSUED---- ----- •-•-- •--- •• ---•--... -....................................... DATE. ................................ <br /> Alterations and/or recommendations: - .••-• •-----... .--••-•.. ......... ...•--•-- ----• -----••.. _....--- ---•----- <br /> - r---- - --- <br /> - <br /> FINAL INSPECTION BY:...... .4.t,lv... tt-_ f <br /> Date........ r ............................................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C"Street <br /> Stockton, California Lodi, California Manteca,California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />