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APPLICATION FOR SANITATION PERMIT <br /> Permit N <br /> (Complete in Duplicate) Date Issued /-2// <br /> AIA t construct and install the work herein described. <br /> Application is hereby made to the San Joaquin Local Health District for a permit o c° •,i,� # f <br /> This application is made in compliance with County Ordinance No. 549; <br /> JOB ADDRESS AND LOCATION.- <br /> --�----}------------------1 <br /> - ---------•---•------•- <br /> - <br /> .}•�^ Phone_5.7_ �.9--------------- <br /> Owner's Name----------L§§-N A-• --------A---- ---� -I--+-�- <br /> - ----------------------------------------------------------- <br /> . Phone--- <br /> Contractor's Name-------- - -- - ------- -------------------------------- <br /> ----------------------------- -----------------------------------....._ <br /> Installation will serve: Residence's Apartment <br /> ❑ ❑artment House Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _._'___ Number of bedrooms -1----- Number of baths ---I--- Lot size ---- '✓'" ------------------------------------ <br /> .. <br /> Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe;( Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 50 New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 5Q ------Material ---- ------- ---------- <br /> Septic Tank: Distance from nearest well---- yfr rrf u ation.. �p <br /> V, No. of compartments..__.-?--------- <br /> � Y_� .aT�. ----Liquid depth--- &t----------------Capacity a 1. <br /> _-.j <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 trench---.--------------------- ------ Q <br /> Type of filter material------------------------- <br /> Depth of filter material-----------------------Total length------------------------------------------ <br /> Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line---.------------- <br /> 171 Number of pits----------------------Lining material-----------------------Size: Diameter---------------------Depth--------------------------------- <br /> Cess ool: Distance from nearest well.__.._.__.._.-Distance from foundation_________________.Lining material___.___._.__.____---.-_----.__-ls <br /> p <br /> Size: Diameter----------------- --- --- -----------Depth-------------------------------------------- -- --Liquid Capacity- -------•------------------ga s. <br /> ❑ Distance from nearest well _ _ m _ <br /> ._ ._ --------------------------Distance fronearest building.___.__..__..__.. __-------------------- <br /> Privy: � <br /> ❑ Distance to nearest lot line-- --------------------------------------- ------------------------------- I <br /> Remodeling and/or repairing (describe):--------------------- -------------------------•------------------------------------------ <br /> --------•--------------------------- --------- <br /> ------------------------------------ <br /> I hereby <br /> ilawshaandh ules prepared lthis at onapplication <br /> olf the San Joaquin the <br /> Localwork <br /> Heawill <br /> ltheDistnc}n accordance with San Joaquin County <br /> ordinances, <br /> ----------------------------------------------------(Owner and/or Contractor) <br /> (Signed �'-- --------------------------- <br /> By:--------------------------------------------------- - - - - <br /> Title <br /> ---------------------------------------------------------------- <br /> --- - ------------------ - -- --------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPART ENT USE ONLY <br /> yr ,4*► DATE <br /> APPLICATION ACCEPTED BY---- �- -- •--------------- DATE <br /> REVIEWED BY------------------------------------------------------------------------------------ --------------------------------- <br /> ------------------------- <br /> _ ----- DATE---------- - - - - ----------------------------- <br /> BUILDING PERMIT ISSUED------------- - - - -- - - <br /> Alter tion and/or recommendations:_. L7_ <br /> 14k <br /> Lf y1 p7s�. Is e � - -� 1 <br /> l �t t�f u <.� i -'.+--- - : 'f;- -- '�-- /� C :.z _ems<� }f ti.. <br /> - w % 'i V ! ° l P /' ���- -- --- _4 :4,41• �'. r <br /> - k <?t 01;f_�t aC ke irs rC_ sr-'" " - 1 `$ ----- -- -- - ------ --- -- -------- --- --- <br /> � �` i <br /> FINAL INSPECTION BY:------ <br /> -------• Date-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street Tracy, California <br /> Stockton, California <br /> Lodi, California Manteca, California <br /> ES-9-2M 0-52 Revised W-2100 <br />