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No. <br /> APPLICATION FOR -SANITATION PERMIT Permit <br /> (Complete in Duplicate) Date Issued <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 <br /> This application is made,in compliance_with County Ordinance No. 549. <br /> 7 <br /> K/- <br /> -_Z __S .4, 1* <br /> JOB ADDRESS AND LOCATION &_ -V-t <br /> Owner ------------------ -------------- Phone---------------------------------- <br /> 's Name--------------------- --- <br /> Address----------------__---------------------------- <br /> -------------------_------ ------------------- <br /> Contractor's Name------------------------------------------------------------------------------------------------------------------------------ - ------------ Phone---------------- •-----•---------- <br /> Installation <br /> hone----------------------------------- <br /> Installation will serve: Residence E] Apartment House El Commercial E] Trailer Court 0 Motel [-] Other <br /> Lot size .-A <br /> Number of living units: -------- Number of bedrooms -------- Number of baths ------ ---—------------------ _­------ <br /> S- <br /> Water Supply: Public system E] Community system [] Private D3-"Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand F <br /> ] Gravel L] Sandy Loam 51--Clay Loam El Clay 0 Adobe El Hardpan F <br /> Previous Application Made: Yes [] No 2- Nlew Construction: Yes 2--90--[] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if publif sewer-is available within 200 feet.) <br /> Septic Tank: Distance from nearest weIjA*__-j-___Disf-ance from-foundaf ion--0 Material.... <br /> y 10 <br /> No. of compartments--.__.-- - ----------Size_14_1A_3t_`e__S'1 Liquid depjh-----;V----------------Capacity__/,.ke_'0------- <br /> i,n- ' e to nearest lot line----' Nl�w I <br /> Disposal PV& Distance from nearest well-3 __-.-Distance from foundation_ --? 4tanc ___mow <br /> Number of 9 lines--- Length of each line-ei of french------ <br /> ------- ------------ <br /> ----------- <br /> Type of filter mater- <br /> Depth of filter material__--1__ length_____ - --- -----------15-0 <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-____._________ <br /> ❑ <br /> ine----------------- <br /> 0 Number of pits----------------------Lining material-----_----------------.Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well------------------Distance from founclatio.n------------------ Lining.material--------1.---------------------------- <br /> Size: Diameter_.-,---------------------------- -- Depth-_--`----------------------- --------- --------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> F-1 Distance to nearest lot line---------------------------- ---- ------------------------------------------------------------------------------------------------------------ <br /> RamQ6oliQ9 ------�JL--------- --------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- -------------------------- -------------------- <br /> ----------------------------------------- -----------------------------------------------------------------------------------------------------------*------------------------------- ---------------------- ----- <br /> ----------------------------------------------------------I--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sfate-laws, and rules and regulations of the San Joaquin Local Health District. <br /> ------------------------------------------------(Owner and/or Contractor) <br /> - --- ---------- - ---------------------------------------------- - <br /> B {Title)----------------------------------- --- . <br /> -----y --------------------------------------------------- --------------_---------------------------------------------------- e - .... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FO RjlyIENT USE ONLY <br /> 4 Z <br /> - ------------------- <br /> APPLICATION ACCEPTED BY__ -. DATE-----:`!/; -1- -5--o <br /> REVIEWED BY------------------------------------------------------------------------------------------------------------------------------ DATE----------------------------------- <br /> ------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------•--- ---------------------------------------------------------- DATE-------------------------------------------------------------- <br /> Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ <br /> ---------------------------------------------------------- ----------------------------------------------- -- ------------------------------------------------------I---------------------------------------------------------- <br /> ---- --- ---- --------------.-:11----------------------- <br /> -------------------- <br /> -----------------------------------------------------------I- --- ------ - ------------------------------------------------------------------------------ Z <br /> -------- <br /> -------------- --------------------- ------- <br /> FINAL INSPECTION BY:-.----------- - - ­ - --- --------------------------- Date <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 10-52 Revised W-2100 <br />