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APPLICATION FOR SANITATION PERMIT Permit No. .-..(D_V_-I--1 <br /> a <br /> (Complete in Duplicate) <br /> __ _ _ <br /> Date Issued _...___ <br /> Applica{ion is hereby made to,the San Joaquin Local Health District for a permit to const ct and install the work herein described. <br /> This application is madeJn compliance with County Ordinance No. 549. <br /> JOB ADDRESS A K1Z LOCATION-----------1 d ` ---------iCJ" <br /> f, 1 <br /> -r, .. --------•--.-.------------------------- <br /> ---•------'------------------------------ <br /> -------_=-------------------•-•--------- <br /> Owners Name----- Phone------------------------------------ <br /> -------------------- <br /> - ; - -- <br /> ---- . r ; . ., <br /> .:.--------•"---------------------------------•-------------------- <br /> Address--------------7G �� --- <br /> Phone---- <br /> --------------------------------------------Contractor's Name__. = <br /> Installation will serve: ::Residence' Apartment House ❑, Commercial ❑ Trailer ,CouFt ❑ Motel ❑ Other ❑ <br /> g �_____ Number of bedrooms �- `Number of baths ._ __ Lotsize ___ c `__ ..f ______.__------------ ---- <br /> Water Supply: Public,s stem P { <br /> Number of liven units: <br /> ' _t y �]""Corrimunity system"❑'� 'Private'❑•'Depth to'Water'Table _f�.p 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 IPS- New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: f f <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T k: tante from nearest well_________________Distance from foundation___"_. ----------- __ <br /> Material-------------------------------------------------- <br /> ❑ � _ <br /> f compartment-s------------------------Size--------------------------------Liquid. depth--------------------------Capacity---•-----=--- ------ <br /> Disposal Field: ► - D'stance from nearest well___.__.__._"__.'Distance from foundation_____________.--_-Distance to nearest lot line----------------- <br /> ❑ er of lines------ ----------- ----- ----------`Length of each line------------------------------Width of trench------------------------ ------= <br /> filter material-------------------------Depth of filter material--_--�" "".. "Total length_I-------------------------..-__-----_.- <br /> 4 <br /> Seepage Pit: Distance to nearest well-- inin�m�teraalCC�F om fatnDite l <br /> r .___.Distance to nearest lot line_"_"_._".--.__.__ <br /> Number of pits. ---- g F - Depth Q"� ,.A. <br /> Cesspool: Distance from-nearest well________________Distance from foundation--------------------Lining material--------------------------------------- <br /> Size: <br /> ____.,_.____"-_____._-._-- _____Size: Diameter---------- ---`Depth_---------------------------------- ------Liquid Capacity------------=--------------gals. <br /> f <br /> Privy: Distance from nearest well--------------------------------------- ------Distance from nearest building----------.----------------------._---_-. <br /> E] Distance`to`nearest;lot line._-I - .- - . :----------------- <br /> Remodeling <br /> - ----- ---Remodeling and/or repairing (describe):-------------------------------------------•-•-----------------•--- '--_..•-------------------•------------------•-•--------••----•----------•-------- <br /> f------------------------­_t -"--------•------------------------ <br /> - } - ---- <br /> ---------------------------------------------- --------------------------------•-----------------------------•--------••------.- ----------------------------------------------------- --------------- <br /> t f <br /> Thereby certify that I have prepared this application and that the work will,be done-'in accordance with San Joaquin County <br /> ordinances, jS+afe 1 and rules and regulations of the`San Joaquin Local Health District. <br /> 4 <br /> Si ned Owner and/or Contractor) <br /> 9 )--- <br /> 01 <br /> tsy:.__ ---------- ------• --- �Title�= ° <br /> [Plot Plan, showing size of lot, location of system in relation to wells,,buildings,.etc'.-,',can be.placed on reverse side]. I <br /> FOR DEPARTMENT USE ONLY,. <br /> APPLICATION ACCEPTED BY_____________�____._____. <br /> DATE---- i <br /> REVIEWED BY----------------------------------- ---------------- --- -- ---- ----- - DATE f <br /> .. f!'------------------------------------- - F <br /> BUILDINGPERMIT ISSUED-------------------------------------- •-------------------------- DATE------ ------ ----.- '- <br /> Alterations.and/or.recommendations:.._..______________ <br /> ------------------- ------------------------­-I ---------- ��� -----------:::_-------- <br /> ----- --- - -----=------------ <br /> { ...-- ------ <br /> - - - --- <br /> ------ - --•------- ---- ------ <br /> ___________________".-"--___-__i-__._____ <br /> 3 F <br /> 77� <br /> �- <br /> FINAL-INSPECTION BY:. -- ` �,? . ._ .. _ . „ - Date._... .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT _Z <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 W-2= <br />