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-`-j-`-'�-----•- <br /> APPLICATION FOR SANITATION PERMIT Permit No.le�_/ f <br /> (Complete in Duplicate) Date Issued -(---- <br /> it to construct and install the work herein described. <br /> s/ <br /> Application is hereby made.to the Son'Joaquin Local Health District for a perm <br /> This application'is made in compliance with County Ordinance No. 549. <br /> ----------------------------------------------------- <br /> ------------- ----------------- - <br /> JOB ADDRESS AND LOCATION----------------- - Phone----.--------------- <br /> I�.- <br /> ------------------------ - <br /> Owner s Name--------------------------------------- <br /> Address--------------------------------•-------------- one ------------------------------- <br /> Ph <br /> Contractor's Name---------------_____________i_._-_--- • ------- Trailer Court ❑ Motel E] Other ❑ <br /> Installation will serve: , Residence A Apartment House [I 'Commercial [I <br /> Number of living units: __-.____ Number of bedrooms _ � <br /> ____- _- --'L=- <br /> -- Number of baths <br /> --- Lot size ------- -- - - - <br /> -- - --r---- <br /> t. <br /> Community system [I Private Depth toWater <br /> aLoama❑ Clay ❑ Adobef <br /> Water Supply: Public system Hardpan ❑ <br /> Character of soil. to a depth of 3 feet: Sand E] Gravel ❑ t Sandy Loam ❑ y r� <br /> Previous Application Made: Yes ❑ No New Construction: Yes [ No ❑ <br /> 12 av <br /> �1 !J <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: k <br /> (No septic tank or cesspool permitted if public sewer ailable within 200 feet.) <br /> ----------- <br /> `p �'t <br /> Septic Tank: Distance from' nearest well_____/u_O'�_Distance from foundation____________________Materia-------_-:Ca acit <br /> )Disance <br /> f compartments_ - 1 Size �X ------Liquid depth------- - P Y <br /> i ,� --------Distance to near <br /> est lot line___-__ <br /> K_- .�?.Wldth of trench. -j} - <br /> Disposal Field: from nearest well-.__11l_ ------Distance from foundation_.___ (� <br /> �j ber oz lines________________ -- ------Length of each line____ _ --- --- e <br /> / <br /> _ Total length_---------- ------------ ---- --- <br /> of filter materiai_____ _.11<-�� ----Depth of filter materia4-__-___�_ ------ --- <br /> Seepage Pit: nce to nearest well-------.Linin mateaale from foundSzenDiameter_ -Dstance t--Dneptest lot }ine--------------- <br /> ❑ ber of p's�s g <br /> i - Dis nce from. nearest we}4-----------------Dis#ante from foundation-------------------- material___-___.-__________-____--_---------- <br /> Cesspool: ___Li Liquid Ca acit ----------------------------gals. <br /> Size ----- ------------------Depth-------------------------------------- --- _ q P Y <br /> ❑ Diameter ---------------------------------------- <br /> Distance from nearest we4l---- Distance from nearest building-- S <br /> Privy: ------- -------------------------------- --- <br /> ❑ Distance to nearest lot line-_______---------------------------- ------ <br /> -----•----------------------------------- <br /> ---------------------------------------- <br /> Remodeling and/or repairing [des tribe]: ---------------------------- <br /> ----- ----------------------------------------•--------•---------•------------•-------------------------------------- --------------------- <br /> i ----=------------------------•------------------------------ _ ----- -----------------------------•------•------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun#y <br /> 1 <br /> ordinances, to I s, and r pies and regulations of the San Joaquin Local Health District. t <br /> ! -------------------------- --------(Owner and/or Contractor) <br /> Si ned <br /> - -------- <br /> - ---------------------------- <br /> (Title)- <br /> By:)__e_�V__x----- ----- - -- ------ ----- - <br /> 0 <br /> y <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYJ -------------------- <br /> DATE---------- <br /> - <br /> DATE------------ ------ ------- ------------- ------------- <br /> ,REVIEWED BY---------------------------- <br /> ` -- ---------------------------- DATE------------------------------------------------------------- <br /> - ------------------------------------------ - <br /> BUILDING PERMIT ISSUED-------t----------------- �- <br /> ------------------ <br /> Alterations and/or recommendations:____________________________ _ __------ <br /> ---•---------------------------------•--f ---- <br /> --------------- <br /> --------------------------------- ---------------------------------------------------------------------­------------ -------------- - <br /> --------------------------------- <br /> --------------- ------------------------------- -------------------------------------------------- -------- -------------- <br /> � qw <br /> Date---------------------- ------------------------ <br /> FINAL <br /> -- -- - ---------------FINAL INSPECTION BY:_--------------- -- --- ------------------- <br /> SAN ----- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> I 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street l 300 West Oak Street Tracy, California <br /> Stockton, California i <br /> Lodi, California Manteca, California <br /> ES-9-2M 10.52 Revised W-2100 �' <br />