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Nil <br /> APPLICATION FOR SANITATION PERMIT Permit No-.�.'3 <br /> (Complete in Duplicate) <br /> Date Issued <br /> lApplica+ion is hereby made to the San Joaquin Local Health District)c*-6 Per <br /> mit to construct and' <br /> This application is made in compliance with County Ordinance No. 549. rd 7711llfh'eow�ork herein described. <br /> JOB ADDRESS AND L <br /> _0CATION_ <br /> Owner's Name..,.-—--------- -- <br /> ------­--------_--- ---------------- ------ --- ------- -- ---------- <br /> Address--- ....Name___-_-._-._._�0'� 7- Phone y--- <br /> -------------------- <br /> Contractor's ------- ---------------------------------------- <br /> ------------ ---- ------------------------------------------- e'- <br /> 1!i� --------------------- ----- Phone---- <br /> Installation will serve: Residenre Apartment House 0' Commercial 0 Trailer Court E3 Motel 0 Other <br /> Number of livin ❑ <br /> g units: Number ❑ <br /> of bedrooms Number of baths Lot size _.!F� <br /> Wafer Supply: Public system .-/ ;�r <br /> Character of soil to a depth of K Community system [] Private [3 Depth to Water Table,,�� ... . . <br /> 3 feet. Sand El Gravel E] Sandy Loam Clay Loam 0 Clay 0'\ dobe El Hardpan <br /> �1� ❑ <br /> Previous Application Made: Yes El IE] <br /> No New Construction: Ye No <br /> TYPE OF INSTALLATION AND SPECI )r -k? w <br /> FICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> SeRtic Tank,_ Distance from nearest well---------- --- --Distance from foundation <br /> No. of compartments-. _------ ......Material.... -------------------------- <br /> -------- ......Size----....... ------ -----.-Liquid depth------------ ------------Celt ap,acify---------------­------ <br /> ();lLsp�t0sal'N I J: Distance from nearest well._---------- <br /> I- ;e C -7/ -Distance from foundation.--------- - -------Distance to nearest lot line------- <br /> Number of lines lines----__-----------_------- Length of each line------- ---------------Width of trench <br /> Type of filter material-_-------_ ------- <br /> ------------Depth of filter material------------------_-Total length---.-___--___.__.-__..-_._..-__.__„- <br /> j <br /> Seepage Pit: Distance to nearest Distance from foAdafion.... Distance to nearest lot line_j <br /> Number of pits._".--/ ----- ------�jnin_g ---Distance <br /> materia-,"--” Size: Diameter---- <br /> Cesspool: Distance from nearest well--------------- Depth- -------- <br /> El Size: Diameter-_._ --------- --- ---- -Distance from foundation - .1-ining material-_.-._.__._._..-_-_---------- <br /> ---- .-.Depth ---------- <br /> ------ - ---- Liquid Capacity-- ---------- ----- ----gals. <br /> Privy: Distance from nearest well ----------- <br /> r-1line__.__.._.-._. ----------Distance from nearest buildin ---- ------------ --Distance to nearest lot <br /> g_ ----------- --- -- <br /> Remodeling and/or ;rppairing (describe):---- <br /> / <br /> -- 4111 <br /> -----­-------------------- <br /> ------ ----------- -- -- <br /> -- -- -- --- ------ .. <br /> ... ............. ---------- - ----- <br /> ---------- <br /> y�e� f Klh� tic wl be, --- a in accordae with San Joaquin-County <br /> repare ton and f at ork I <br /> 0 ;nancas, Ste s, and rul an regulations of the San Joaquin cal Health District. <br /> (Signed)_,.... ------ Owner and/or Contractor) <br /> By:........... . . -- ---- <br /> ------------------------ -------- <br /> (Plot plan, showings a of lot, 14ation of system in relation to wells, buildings, etc., can be plc dW on reverse site). <br /> 4Z FOR DEPARTMENT USE ONLY <br /> I-----­-------- <br /> APPLICATION ACCEPTED BY--- -------- ----------------------------- <br /> DATE... <br /> REVIEWEDBY--------------------------------------------------*-------I-------- ----------------------------------------------------. DATE------ - - - - <br /> BUILDING <br /> ATE-------- <br /> BUILDINGPERMIT ISSUED.._.... ---------------------------------------------------------------------------------------.. DATE.----------------_---------- ---------- -------------- <br /> Alterationsand/or recommendations:-------------------------- ------ -- ---- ---_------------­------------------------------------------------..........................._------------------------------ ---------------------I---------- -- ----------------------------- -------------- --------- -------------------­_-------------------------------------------................... <br /> --------------------I---------------------------------------- ----------------------------------------------------------------------------------------------------------------- -------------- <br /> --------------------------------------- -- ------------------- ------- --------- ----1__. ­ ----------------------------------------------------------- ----------- ---------------------------- <br /> ------------------- -- --------------- -- ------- ----I-----------------------I--------------------------------------- <br /> FINAL INSPECTION BY:. -------- - ---------------------- ------------------- - Date------------- <br /> --------- --------- <br /> SAN JOALOCAL QUIN H DISTRICT <br /> 130 South American Street 300 West <br /> Oat Street L3 2 Sy a..,. Street 814 North "C" Street <br /> Stockton, California Lodi, California Maiifeca, California Tracy, California <br /> ES-9-2m - Revised W-2100 <br />