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<�v` APPLICATION_ FOR SANITATION PERMIT Permit No. ------`................ <br /> 1 Jy �' . <br /> �1 L�� O (Complete in Duplicate)" pate Issued .__ ------­­------ <br /> A <br /> _�..-�_ <br /> I 1 <br /> Applica+ion 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. <br /> 549. <br /> JOB ADDRESS AND LOCATION------ 9--. a..--.,r1:,E! -----------------------•---------..----------------------------------------------- <br /> Owner's Name------ ------------- / ,_� Phone <br /> Address_.---_91-:2 '8-d ---- 1------- <br /> - - ---------------. --------------------------------------------------------- -----------------------�--------------------------- <br /> Phone_l7= x Contractor's Name---- --------------------- T _.-! ._.. <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ fMotel ❑ Other ❑ <br /> Number of living units: __I__ Number of bedrooms __ * Number of baths ___ Lot size .---- -__________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table �d ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑- Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3 Hardpan ❑ <br /> Previous Application Made: Yes ❑ No M - New Construction: ;Yes Ig—No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' a <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F <br /> T � <br /> Septic Tank: Distance from nearest well 4_A4istanc9, from ----------___________- <br /> No. of compartments--------L-------------SizeS�X�10S/----Liquid depth___A/_7 ------------Capacity..... Q_!- - <br /> Disposal Field: Distance from nearest well-------_-------__Distance frcgTjoundation_='_"'!,"________.Distance to nearest lot line___________ <br /> Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- r <br /> Type of filter material------€------------------Depth of filter material----------_---`_E -----Total length----------------------------------------- 4 <br /> Keepa,ge Pit,: Distance to nearest well--- -----------------Distance from foundation_:_---._i_!_..___.Distance to nearest lot line----------------- <br /> Number of pits----------------------Lining material---r _ _ -------- <br /> - _ Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: v Distance from nearest well_____-l_ Distance fron) foundation____________ __. <br /> _+____.Lining material ------.______________.____________- <br /> ❑ Size: Diameter------------------------------'._Depth-------- _7�-------------------------------------- q Capacity_ _Li Liquid Ca acit gals. <br /> Privy: Distance from nearest well__-----------------------------------------------Distance from nearest building___________________-_--__________________- <br /> ❑ Distance to nearest.lot line------------------------------------- ------ ---•--------------------- •-----------------------------•------------------------------------- <br /> �},_ f <br /> Remodeling and/or repairing01 <br /> f. -------- <br /> ------------ <br /> --------••----------------------------- ------------ <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, State laws, and rules and regulate s of t e San Joaquin Lo al Health District. <br /> �4 <br /> (Signed--------------- •------------------ ------- ---------- ------ -----------•----- -- ----(O er and/or Contractor) <br /> - .�GS..<` --------------------------------•---------(Title)- <br /> BY� ----•------ <br /> (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------------------- -- 1/58j----------------------------------------- DATE------ o�---�------�at ------------ <br /> REVIEWEDBY---------------- - ------------------------------------------------------- DATE--------------------... <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ •---•-----------------------------------•--- <br /> Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------•-•----....------_----------------•-- <br /> -----------------------------------•---•- -----•-••-•------••-•---------•--•------------------------ ------- ------------------------•-------•------------------------------------•------•------------------------------••---- <br /> ---------- -------------------------------------------------------•-- -----------------------------------------------------------------------------------------•---------------------•--------------------------------------- <br /> ---•------------------•-----------------------•------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------•--•----------- <br /> �j //, — d <br /> FINAL INSPECTION BY---------------------------------U �� _ Date <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 />