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Perm-it No- ----- - - -------- <br /> APPLICATION FOR SANITATION PERMIT <br /> (complete in Duplicate) Date Issued --------- <br /> rk herein described, <br /> Joauin Local Health District for a perm;f to construct and install the wo <br /> Application is hereby made to,the Sol qOUp-drice No. 49.This application is made in compliance with Countyrc <br /> :npliance --------- ------- <br /> ----------- <br /> JOB ADDRESS A LO TION -------- ---- ---------------------------------------- Phone_----------------------- <br /> _W------­----- -------------- ---------- <br /> !X - -------------- ----- - ------------------------------------------------------------------ <br /> Owner's --------------------------------- <br /> Address------ - ------ I--- ------ - - --------------------------------------------------------------------------------------- Phone-----------Other---------------------- <br /> ---------- -------- <br /> Contractor's Name__ - ---- -- -- ❑ <br /> ----- Commercial C] Trailer Court 0 MOjel <br /> .Residence Apartment House �0110 _A__Vcz�--------------------------------- <br /> Installation will serve: R6side' "? 1fhs J---- Lot size ----------------- - ------ <br /> rooms - Number <br /> Number of bed N b <br /> Number of living,unifs' Community system 0 Private 2( Depth to Water Table ------- ff- Adobe Hardpan 0 <br /> i' <br /> Water Supply: Public.;.SYst1m andy Lo Clay Loam 0 Clay 0 <br /> Character of soil to a.depth of 3 feet: Sand ❑ Gravel 0 S Loa <br /> New Construction* Yes 0 N%11 <br /> Previous Application Made: Yes 0 ;�Or <br /> TYPE OF INSTALLATION AND SPECIFICATIONS-. available within 200 feet) I <br /> -pool permitted if pujic s7wer is M t ral ---- ------------ --------------- <br /> rorepun <br /> SO-0----- <br /> (No septic tank or cesspool Distance Liquid depf-b __Eapaci I <br /> Distance from --j,57�---- d inn___; Wj -I <br /> nearest we�l --- ----------- <br /> Septic <br /> Xank: of compartments______-___ -------- <br /> ---- j----- __Size_ 4 <br /> No. �,"T [ion nearest 10 <br /> _Distance from foundation}__ -1-------Distance to na ------------- <br /> Dispos Field: Distance from nearest wellj- <br /> Length of each line---------1--';4,t-----Width of french________- -------- <br /> Number of lines---_------- - -------- -Total length---- <br /> Type of;filter rnateri Depth of filter material-------1­0-------- <br /> e from foundation--------------------Distance to nearest lot <br /> Seepage Pit: Distance to nearesl well----------------------Distaric Size: Diameter------------- Depth-------------------------------- <br /> Distance <br /> Of pits----------------------Lining material--------------------- _-Lining material------------------------------------ <br /> ❑ <br /> m nearest well --------- --------------gal <br /> Distance fro ----------------Distance from foundation-------------------Liquid Capacity------------- -- <br /> Size: Diameter------- ------------------------------Depth--------------------------------- ------ <br /> F1 Distance from nearest. building__________________ ----------------- <br /> Privy: Distance from nearest well----- ----------------------- ----------------------------------------------- <br /> -- ---------------------------------------- <br /> ❑ Distance to nearest lot line--------------------------------------------------- ---- <br /> ------------ ----------------------------I------------------------ <br /> ----------�­----------- ------------ <br /> Remodeling and/or repairing (describe)-------------------------------I------- -------------------- <br /> ------------------------- ----------------------------------------------------------------------------------------- --------—------- <br /> ----------------------------- --------------------------------- ----------I------------------------11------------------------------------------ <br /> ----------------11---------- -------------------------------- <br /> ----------.......-------------- -------------- <br /> ----------------------------------- -------------------------------------------- <br /> -------- ----------------------------------- in County <br /> ----------------­- i I-, <br /> -----------------------------------••---------------------- <br /> -------------------------------­----------------------- J that the work will be done in accordance with San Joaquin <br /> I hereby certify that I have prepared this application am Joaquin Local Health District. <br /> ordinances, State laws, and rules and regulations of the San. (Owner and/or Contractor) <br /> ('A------------------------------------------------------------------------------------------------------------- <br /> �l�o VI. __ - ------------------------------------­­( 'g ]----41-f C�R__ <br /> --------------------------------------------(Title) <br /> BY:--------------------- 7 ------------------------------------------------- wells, buildings. etc., can be placed on reverse side). <br /> . , 0 of system in relation to <br /> (Plot plan, showing size 0 locationFOR DEPARTMENT USE ONLY <br /> DATE_1� ------------------------ <br /> ------------------------------------------------- --I---------------------- <br /> APPLICATION ACCEPTED By DATE ---5;�,<--------------------------- ------------------- <br /> ----- ----------------------------------------------------------------------- -_ 1p' ----------------------- <br /> REVIEWEDBY-----------------I------------ ------------------------------------------------------------------------------------------------DATE_ -----------V----------------------------------- <br /> BUILDING PERMIT ISSUED------------ I-------------------------------------------------------------- �)-------- <br /> r recommendations' ------------------- ------------ <br /> ------ P'__VA)y--------- <br /> ,-(­.�-- ------------------- ---- <br /> Alterations and/or -------- -- <br /> ;- ------------------ -- ------� <br /> ------ - ------------------ ------�e� FE-2---- <br /> ------------- r--------- ------ ------ 4 <br /> -------------------7 ------ ---- ---- <br /> ------------ -- <br /> --------------------- <br /> --------------------------------------------------------- -------- <br /> ------------ ----- ------- <br /> (Z�r ----- ----------------------------------------- ---------------- ---------- <br /> ---------------- _ ___. <br /> -------- ------------- ------------------------------- <br /> -----------------------------------------:------------ ---------------------------------- <br /> V <br /> Date--------------- <br /> FINAL INSPECTION;'BY------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT North "C" Street <br /> 132 Sycamore Street <br /> 300 West 0alk Street Tracy, California <br /> 130 South American Street Manteca, California <br /> Stockton, California <br /> Lodi, California <br /> ES-9-2M B-51 Revised W-2100 <br />