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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued ----7----- ------- <br /> 00( -2-00 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made-in compliance with County Ordinance No. 549. <br /> 3 7 V.v <br /> JOB ADDRESS AND LOCATION:� --C--------- <br /> ----------- ---------------------------- <br /> Owner's Name-- -0 1a --------6-_2 .....& W <br /> Phone <br /> Add -------------------- <br /> ---------- <br /> ---].FOY------Ay-A-------------1pr�114;_ <br /> ------------------------------------------------------------------------------------------------------------------------------------- <br /> 1# <br /> Contractor's ------------------------------------------------------------------------------------------------------------------ Phone----------------------------------- <br /> Installation will serve: Residence M Apartment House E] Commercial F1 Trailer Court ❑ Motel El Other El <br /> Number of living units: _1.-___ Number of bedrooms Number of baths I---- Lot size J---------------------------------- <br /> Water Supply: Public system 0 Community system E] Private R] Depfh­toWate7 ft. <br /> Sand E] Gravel 0 Sandy Loam ] Clay Loam-& i <br /> Character of soil to a depth of 3 feet: Clayo Adobe R] HardpanEl <br /> Previous Application Made: YesF1 NoFL] New Construction: Yes Ej No 4 FHA/VA- Yes [j No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> - .(No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-_­�--­0 <br /> ---------Distanceffrom foundation---/0------------Maferial__W�4�---------------------- <br /> No. of compartments-------f97---------------Size---94 ----------Liquid depth------4-----------------Capacity____,?-_0V---------- <br /> Disposal Field: Distance from nearest well-S-0--------Disfance from foundation---1--Q----------Distance to nearest lot line______-_____ <br /> Number <br /> ine----r-------- <br /> Number of lines---7A-- ___/----------------Length of-each line--SID.....................Width.kof french----��4Y----------------------- <br /> Type of filter material ----Depth of filter material---I.F 4------------Total length--- -- ___________._ <br /> Seepage Pit: Distance to nearest welf------------'---_____Distance from foundation----------------_-Distance to nearest lot line-____-_.-_-______ 00 <br /> ❑ Number of pits----------------------Lining material------ ----------------Size: Diameter------------------------Depth-------------------- <br /> cesspo,ol:, Distance from nearest well-----------------Distance from found1fion4------------------Lining material___._______________._______________- <br /> � ❑ Size: <br /> aterial-------------------------------------- <br /> S;ze: Diameter------------------------ ------------Depth----------------------------A --I-------------- -Liquid Capacity- - ------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------_--------------------_:-_ ,; r- <br /> , �,❑ - <br /> Distance <br /> uilding-------------------------------- <br /> Distance to nearest lot line------------------------------------------------I <br /> ------------------------------------I---------------- ------------------------------------- <br /> Remodeling a-nd/or repairing Idescribe):------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Z <br /> ----------------------------------------------------------------------------------------------------------------- ------------------------------- -------- ------------------------------------------------------------------ <br /> _% - . / ------------- <br /> -----------------------------------------------------------------------------1--------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------ --------------------r-----------------lwti-----:-------------------------------------a..--------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have'prepared-fhis.applicafion and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sf t laws, and rules and requlafions-of,fhe,San Joaquin Local Health District. <br /> I PT <br /> (Signed)-------- --------- ------------------------(Owner and/or Contractor) <br /> ----------- --------------- --------------------------------------------------------- <br /> % it a - -� ---� <br /> By:--------------------------------------- -----------------------------4--------a,---------------------------------------------------(Title)--------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse tide). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- -- ---- --------- ------ -------------------------- ---------------------------------------- DATE A-7- f---------------------------- - <br /> REVIEWEDBY------------------------------------------------------------------ -----=----------- ---------------------------------------- DATE------- ----------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations:------------------------------------------------- -------------------------------------------------------------------------------------------------- --------- <br /> *0. L_ - - 4 <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------I---------------------------------------------------------------I--------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------- ---------------------------------------------------------------- -------------------------------------------------------------------------------------- <br /> -------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION -------------------- Date------- 4I__.----- <br /> ------------------------------------------ <br /> SAN <br /> �------------------------------------------------- <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 - Revise* 1.57 F-?-CO. <br />