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APPLICATION FOR SANITATION PERMIT Permit No. ................ <br /> (Complete in Duplicate) <br /> Date Issued ... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> his application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS I,Q ATIOt 1-_ _ ,_ _z •• . f............��.�,L••� ... �... �.. <br /> Owner s Na e. .W -•-•-------------------------------------------- ---------------------- <br /> J --------- Phone-.6..4--- <br /> Address------ --------------------------•-----•---- ------------------•----------- -------- <br /> Contractor's Name - __-._-=- ----------__ ---- Phone .-_ �. . "����--- <br /> Installation will serve: Residence Apartment House ❑ Commercial F1 Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---I--- Number of bedrooms ___ Number of baths ---I... Lot size <br /> CE�✓u ................... <br /> hWater Supply: Public system [ICommunity system ❑ Private 2Depth t titer Table �V...Fft. <br /> .Character-of sdil#o._a depth of 3 feet: Sand[-] Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Madec Yes j] Nd &1--"New Construction: Yes g�--`No ❑ FHA/VA: 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 /> Septic Tank: Distance from nearest well_________________Distance-frgk foundation___.-__----_----__.Material <br /> .—M - *,,I No. of compartments--------------------------Size--_------------ - -:-.----Liquid depth --------- --.-.-----Capacity.......................... <br /> DisposalFie : Distance from nearest well „_-___---__--Distance from foundation-------------_----Distance to nearest lot line........... <br /> -_ 'Zo Number of lines_____________ ------ ---Length of each line_=_____ __.__.-_...Width of trench _---_:--•..___--__---___.-_. <br /> 1 Type of filter material-------------------------Depth of filter material-----------------------Total length--..-_ ................... <br /> � <br /> Seepage Pit: Distance to nearest well :------Distance from found"ation.. ! 1. .._.Distance to nearest lotline 4 .t <br /> Number of pits-_ ._-`Z-.-_________Lining,mate ria L_.__ '�:et:-__-. Size: Diam'oter____...�...--_---___Depth----- __ ----.- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_ __-- <br /> ❑ Size: Diameter-------------------------------------Depth-------- ----- •-------------- ---------.-_Liquid Capacity •------•-_----- gals. <br /> ®r-Ivy: Distance from nearest well-------------------------------------------------Distance from nearest building-____ _______ --_-- _----_. <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------•-------------------------------------- <br /> Re <br /> --------;---Re delin and/orre airing (des ribe)•----- �' -' '" � � f {/ ._ - .__.. <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) __.. �_ ..XAJ <br /> __ - ---- -- ----------------------- ( er and/or C actor) <br /> -- -- --------- ------------------- -- ----- Own Contractor) <br /> --- �11.�„y - ate:------------------ ----------_--------_-------- ---- (Title)_ ---- --------- ----------------- <br /> (Plot plan, showing size t, location of system in relation to wells, buildings, etc., can be placed on reverse'�ide). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- --" ----------------------------------------------------------- DATE."--- / {` <br /> REVIEWEDBY---------------------------------- --- ----- --- ---- ----------- ------- "-_-_------------ DATE -•.7 -•"--..�J`�".-.�:­----.-.-.-.-.- <br /> BUILDINGPERMIT ISSUED--_-- _--------- --------------------------- ------------------------------------------ DATE---------------------- ----- <br /> Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------•---"--"--•---•---•"-••-----••••••----•--••.--"•-•--•-••................... <br /> ------------ --------------------------------------- """---"--- "-- . ......................................................... <br /> ---------------------------------------- ----------------------------------------------------------------------------- --- i - -- ---------------------., ............ - <br /> g ¢ <br /> ________________ _______________________________________________________ ___________________ ___________________• :!- -------------------------­._... .... ._.... _"_'_ <br /> FINAL INSPECTION BY:----r�k' --- - ------------ - ------- Date--------�: -----------... ...._._. _.-.:_ ..__.__............. <br /> . <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 Revised -57 F.P.CO. 5 <br />