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7 <br /> APPLICATION FOR SANITATION PERMIT Permit No. - - - -- ------------- <br /> (Complete in Duplicate) t <br /> Date Issued _1a- <br /> Aplicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> " application is made in compliance with County Ordinance No. 549. <br /> t?-6 _s7z 4 <br /> DRESS AND LOCATION-- <br /> - ----_ ----- YZI,ez.e <br /> JOB A6 — <br /> ------------------------------ ------------------------------- <br /> - -- ------------------------ <br /> Owner's Name------------------------------------ ------------------------------------ Phone--- '!1° ------ <br /> Address--------------------------- _2/- <br /> ------------­....... ..... 2----=------ - -----•- -•-- ---- <br /> - <br /> A. <br /> Contractor's Name_________________________ <br /> J-7- <br /> -------------------------- Phone____-11�•7 .------- <br /> Installation will serve: Residence E] Apartment House E] Commercial El Trailer Court El Motel El Other 91 47x,./w <br /> Number of living units.- ---I"Number of bedrooms Number of baths _A�� Lot size -------------- -------------- 0 <br /> Water Supply: Public system E] Community system E] Private D? Depth to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel El Sandy Loam El Clay Loam E] Clay ❑ Adobe 0 Hardpan ❑ <br /> Previous Application Made: Yes Ej No X New Construction: Yes Of No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu6lic sewer is availa6le within 200 feet.) <br /> Septic Tank: Distance from nearest well�OA6_Distance rrl founclation-Za <br /> ko ---------Material--- -4-- -------------- <br /> ..................Size <br /> No. of compartments---- --------Size_46�_&--- -K.-Liquid depfh--.Z---57------------- <br /> Mr 749 <br /> ,nc, n <br /> Disposal Field: Distance from nearest wellcl-0-0-------Distance rom foulredliion------/---0_-'___Distance to nearest lot line-- ------- <br /> Number of lines--------- 3 Length of each line- !------W W `�Width of trench__.-rR_1V1 -------------- <br /> o ----- <br /> Type of filter ---Depth of filter material-J)? ------Total Iength---16--ko- -- <br /> ' ------ <br /> --- --------- <br /> Seepage Pit; Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_.-__-_--________ <br /> ❑ Number <br /> ine----------------- <br /> Number of pits----------------------Lining material----- _-------------. Size: Diameter---------- ------------Depth------------------------------- } <br /> Cesspool: <br /> epth----------------------- <br /> Cesspool: <br /> Distance from nearest well-----------------Distance from foundation--_----------____.Lining material__--_---_________________--__________- <br /> T'' <br /> ❑ <br /> aterial--------------------------- - ------ <br /> El Size: Diameter------------------ -------------------Depth--------------------- -----------------------------Liquid Capacity----- gals. <br /> Privy: Distance fr'om nearest weJl--------- ---------------------------------------Distance from nearest building---- ----- ------- <br /> ElDistance to nearest lot line----------------- ----------------------- --------------------------------------------------- ----------------------------------------------- <br /> Remodeling and/or repairing (describe):------------------------------------I--------------------------------------------------------------------------------------------------- ----------------- <br /> -------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------I------------------------------------------- <br /> ---------------1-------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- <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, an,d rules and regulations of the San-Joaquin Local Health District. <br /> (Signed)--------- <br /> --------- -------------,_jewmr-_anj�ar Contractor) <br /> By:----------- ----------------------------------------------------------------------ITif Ie <br /> (Plot plan, sh sze of lot, location of e <br /> in relation to wells, buildings, etc., can 6e placed on reverse side). <br /> ' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 13Y(�! ----------- DATE_C�� <br /> ;1-05--------------- ------------------------------------ <br /> REVIEWEDBY--------------------------- ------------------------------- --------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED------------- <br /> -- --------------------------------------------------------------------------- DATE-------- <br /> Alterations and/or recommendations:---------------------------------------:--------------------------------------------------------------------_------------------------ A <br /> ---------------------------------------------------------------------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- <br /> ----------------------------------------------- ------------------------------------------------- --------------------------------------------------------------------------------------------------------------- <br /> --------------r------------------------------------------------------- ------------------------------------------------- --- ----------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:------ -- --------------------------- Date--- <br /> SAN <br /> ate---SAN JOA9UIN 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 8-51 Revised W-2100 <br />