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\�'V\ Permit No. .___�a.7�-3• <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Da+a <br /> Issued --- -- - - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constct and ins#a4l the work herein described. <br /> This application is made in compliance with County Ordinance�NQ. 549.� ---- , 6�--------- <br /> . -- --------------- <br /> Phone <br /> .. -- L -...... <br /> JOB ADDRESS AND LOCATION------------------------�---------- <br /> -� . - r <br /> -� 'Z' f Phone-----------••----------------------- <br /> r W> r � <br /> Owners Name 1.,. t� = ----------------------------- <br /> Address-------------------------- L -L------ '------ ------ = ----=---------------------------------------------• -------------------------- <br /> �'fi` u --------------------------------- ---------------------------------------------- <br /> Contractor'sone.. 7 <br /> �1 <br /> Ph <br /> Name----- -- --------------- <br /> Installation will serve: Residence F1 Apartment House E] Commercial E] - Trailer Court ❑ Motel [I Other El <br /> Number of living units: -------- Numbdr of bedrooms ------ - Number of baths -------- Lot size ..- _ .,-__- C/ <br /> Water Supply: Public system El Community system ❑ Private [B- epth to Water Table �/S ft." ' <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel I] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe L'f Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ FHA/VA: Yes ❑ No ❑ <br /> } TYPE OF INSTALLATION AND SPECIFICATIONS: y'' <br /> (No septic tank or'cesspool permitted if public sewer is available within 2D0 feet.) J <br /> / � . <br /> Septic Tank: f 4- <br /> Distance from nearest well_ -Z.--Distance from foundation_,/----_.-_...Material.`--.-_-.- ......__. <br /> - 9J <br /> No. of compartments u - Size - Liquid depth----`5--��`— -------Capacity-- <br /> :?'7 <br /> Disposa4 Field: Distance from nearest well-_J ..__...-:.Distance from found t;o - -0_,------Distance to nearest lot line....._...-.J_. <br /> Number of lines--------------------; Length of each liner�V__��--� ;� �-'Width of trench... _/___._._i------------------ <br /> Type of filter materiaL___ i_ ��.Depth of filter material_.__ Ei� -------Total length.---_.�z�. ?...............L.. <br /> Seepage "it: Distanceyto nearest well. p ___:Distance . m .foundation ._...-__-istance to nearest lot line. ._.._...-_._ <br /> � Number of pits.--,3------------- material-- -__-Size: Diameter--_1� -------.Depth-----^-S_------------------ <br /> r ..Li uid Capacity ---------------- - <br /> ' Cesspool: Distance from nearest•well.._...-_--------Distance from foundation-=------------------Linin material----- -------------------------------- <br /> -Liquid <br /> -_.-_-..-----. <br /> ❑ Size: Diameter-------=--------'--------- -- <br /> Depth - q p gals. <br /> Privy: Distance from nearest well_---_--.:__......-------...._.--------------.Di <br /> stance from nearest building___.- <br /> ❑ Distance to nearest loft line.----- `'--- ---------------------- ------------•------------------------_------ <br /> i � E Y <br /> Remodeling and/or repairing (describe)----------------------- <br /> i - -_------------------------------------- <br /> - = <br /> -------------- -------------------------- <br /> ------------------••-----------------•--------------------------------------------- ----------------------•---------------- <br /> I. 1,,r <br /> __ <br /> ----------------- <br /> -----------------------rState fy t and r les rep red this <br /> applflthe San Joaquin Local Health District.-----_or -- _-.--- Sa -ui <br /> I hereby- r ' that I have prepared this a lication and that the work will be done m accordance with San Joaquin County <br /> ordinances, <br /> l C Y E <br /> r ,. Owner and/or Contract <br /> (Sign _ ` �----------------------------------- <br /> ed) �-�� --------- --�� f <br /> _ _ �_ ,cr-�-_.Gi{/�._--- -C --- - ` "----------------------••--- -----(Title)-------`-l-•= t-------------Plot plan, showing size of to+, location`of system in r,'dla ion to wells, buildings, efc k can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> y <br /> APPLICATION ACCEPTED BY---- TkR-.Q r--------------= --------------------- DATE4 S <br /> REVIEWEDBY------------------------------------- ------ ­­­----------- DATE--------=- •-------------------- --------- <br /> l� DATE <br /> BUILDING PERMIT ISSUED------------------------------ <br /> e � ---- <br /> --------•----------------•-- ------------------------ <br /> Alterations and/or recommendations:---:_. - T5pE� - — - -------- <br /> ----------------------------------------- -------- ---------------------------------- ------ ..--------------------- <br /> -- ----- ----------------------------------------------------------------------------------------- <br /> -------------------------------- <br /> z/00- <br /> - --- ----------------------------- ----------------------------------•-- <br /> FINAL INSPECT-10.N BY, -y ------------- -------- = Date `� �' J� -.. <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 1.57 F.P.Cb- <br />