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T1 `6 sv� <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> �-• ._�•. Y . Date Issued -----�.1_ <br /> Applica-lion is hereby made to the San Joaquin Local Health District for a p mit t cohstruucct and install the work herein described. <br /> _ <br /> This application is made in compliance with County Or ante o. 54 " <br /> J08 ADDRESS A CATION. (9- __ .. ON----- -----'.. <br /> --� - --------- <br /> Owner's Name-- - L / C,�--------� r----•--- -- =----------- -- Phone-- <br /> ---------------------------------- <br /> Address-------•------------•• x _ <br /> .--------• ----------------------•--•--•----------•------------ <br /> •-------•----------• --------------------•- <br /> Contractor's Name <br /> Installation will serve: Residence J4 Apartment House ❑) tCommercial _❑ Trailer Court L] Motel ❑ Other E]F Number of living units: _�___. Number of bedrooms _,VNumber mber of`baths _ ____- Lot size -_7,s--X--1 P_P1 <br /> Water Supply: Public'system 4 Community system ❑ Private ❑ .Depth to WaferTable-p��ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobel` Hardpan ❑ <br /> Previous Application Made: Yes ❑ No KI New Construction:.Yes ❑ No M <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: k T <br /> (No septic tank'or cesspool permitted if public sewer.is available within 200 feet.) <br /> . ,. <br /> Septic Tank: g'& Distance from nearest well-----------------Distance from foundation--------------------Material <br /> _________. <br /> ❑ No. of compartments ------Size-------------------------------•Liquid depth-_------------------------Capacity <br /> Disposal Field- Distance from nearest well-----------------Distance from foundation___..---------------Distance to nearest lot line_______.._____... <br /> ❑ dFxj.5J" Number of lines-----------------------------------Length of each.line------------------------------Width of trench ,- Oq <br /> ------------------ <br /> 1 Type of filter material_________________________Depth of filter material------------------------Total length------------------------------------------ <br /> Ir <br /> Seepa'g'e <br /> ___--_______--______ ______ ---- <br /> eepage Pit: Distance to nearest we11'/1CQKC,__- --Distance fromJo dation_ ..._.__.Dist ace to nearest lot�ine__/2-_ 4 <br /> Number of pits---+ �' _----.-Lining material-_00--t-6k. <br /> Size: Diameter_3.�_____..____De th_ �1 <br /> P ----•------�----- <br /> Cesspool: Distance'from nearest well-----------------Distance from foundation----------------.—Lining material__________________________-_-_______- <br /> ❑ Size: Diamefer----------------`--- ---------------Depth---------------------•- ------ ---------------Liquid Capacity----------------------------gals, <br /> , <br /> Privy:# Distance from nearest well------ ________Distance from nearest building_____________._:_________ <br /> ❑ Distance to nearest lo+line"-------------- ----------- <br /> r • <br /> Remodeling and/or repairing (describe).:-- ---------------------------------------------------------- <br /> ------------ <br /> --- ---------------------------•-••--------------------------------------------------------------------- <br /> ------------- _..•---------------------••-• <br /> ----------------------------------------------------------------------------------------------------------•--------------------------_--------------------- --•--------------------•--------------------------------- <br /> I hereby certify +hat-1 have epared.t application and.,that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rul s regul ' ns of thL <br /> aquin Local Health District. <br /> (Signed)-------------------------r...- --- ------- -------- - ----- -------------- ---------------- ----- ----------+ --- Owner and/or.Contractor)' `.: <br /> By:------------•--------------=-----I---•-•••----- t _ Ti+le <br /> ---- {------ -- --------- <br /> (Plot pian, showing size of Iot location of system in relation to wellsldings, etc., can be place n reverse side). <br /> ) <br /> • FOR DEPARTMENT USE ONLY <br /> ------- <br /> APPLICATION ACCEPTED BY --- ------- - }DATE f�� <br /> REVIEWED BY------------- - `_ ­- . . A- _ _ "i �------------ <br /> - -------------------- - - DATE :------ <br /> - -----------------•-------------- <br /> BUILIJING PERMIT-ISSUED----------------•---------- <br /> DATE----------------------- <br /> Alterations and/or recommendations:-------- ---------%----------------------------------------- <br /> -----------•------------------- -------------- -- <br /> . --1 - -- -------------------------------------------- <br /> ------------- -`=-- <br /> ---------- ----------- ------------- <br /> .. <br /> �--.� ---------- <br /> ---------------- <br /> � �.. . <br /> -_ <br /> ------------- <br /> ---------- <br /> FINAL <br /> ------•--=fNAL INSPECTION BY:: °` Date___ f- - - ------ - ------- <br /> SAN ; <br /> i <br /> 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 W-2100 <br />