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APPLICATION FOR SANITATION PERMIT Permit No. <br />(Complete in Duplicate) <br />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 application is made in compliance with County Ordinance No. 549. <br />JOBADDRESS AND LOCATION.... ------- t - ------- ------- ---------------------------------- ­ ----------- --------------- ------------ <br />Owner's Name--------------- -- - ----------------- -------- -- - -------- ------------------------------ /f---- --- - Phone --------------------- -------------- <br />Address------------------------ ... ...6--- .. ab ---- -- -- ------ --------------------------------------------- ------------ <br />Contractor's Name---- ---A - - ____ - . --------------- ---------------------------------------------- ---------------- Phone ----------------------------------- <br />Installation will serve: ResidenceA Apartment House F / Cher , <br />] Commercial E] Trailer Court [] Motel. -E] 9 El <br />Number of living units. _j--- Number of bedrooms _-/__ Number of baths ---- )--- Lot size ---- � K 2� ---------- --- ---- kk__4 ----------- <br />Water Supply: Public system Community system El Private F-1 Depth to Wafer Table -------- ft. <br />Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam [] Clay Loam [I Clay El Adobe Hardpan <br />❑ <br />Previous Application Made: Yes E] No�New Construction: Yes �o E] FHA/VA; Yes El No <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or' cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank: Distance from nearest well IaJ ------ Distance from founclatio * n --- /40 ----------- <br />No. of compartments._._ -- ---- ------------ Liquid -dep�h___ --- 90— <br />�& e__ Y ------------------- Capacity --j"60 <br />Disposal Reid: Distance from nearest wel,10,01LAW-Distance <br />from found afion_ 2-0 ............. Distance to nearest lot line ---- <br />Number of lines ----------- ---------- Length of each line --e ---- 0 -- ----------- Width of french ly ------------------- <br />T). <br />Type of filter material-V4,A-1 — --------- Depth of filter maferial-_/Y .............. Total len. _-__-__----_____--_ <br />Seepage Pit: Distance to nearest well ----------------------Distance from foundation ------------ ....... Distance to nearest lot line------.____-_--_ <br />❑ <br />ine------ ---------- <br />F Number of pits ----------------------Lining material -----------------------Size: Diameter ----------------------- Depth --------------------------------- <br />Cesspool: Distance from nearest well -----------------Distance from foundation------------_ ----.Lining material ------------------------------------- <br />LjSize: Diameter -------------------------------------- Depfin ---------------------------------------------------- Liquid Capacity ----------------------------gals. <br />Privy: Distance from nearest well -------- ---------------------------------------- Distance from nearest building-__-----_--_----_-__----_____-____-----. <br />ElDistance to nearest lot line----------------------------------------------- ------------------------------------------------------------------ --------------------------- <br />Remodelingand/or repairing (describe): ------------------ ----------------------------------------------------------------------------- -------------------------------------------------------- <br />------------------------------------ I—_ ----------------------------------------------- --------------------------------------------- --------------------------------------------------------------------------------- <br />------------------------------------------------------ I., ----------------------------------- I ------------------------------ ­­ ----------------------------- - <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 regulations of the San Joaquin Local Health District. <br />Si <br />(gned) --------------------- <br />----- ----------------------- --------------- -- ------------------------------------------------------------- (Owner and/or Contractor) <br />By: ------------------------------------------------------------------------------------------------------------------------------------ (Title) ---------------------------------------------------------------- <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY-------.,- <br />---------------------------------------- DATE ----- <br />REVIEWED ---- ----------------- <br />DATE ----- <br />� <br />__4 <br />REVIEWED BY ------------------------------------- - - - <br />BUILDINGPERMIT ISSUED--------------- - V ----- ----- -------- - - -- --------------------------------------------- DATE-------------------------- ---- <br />--------------------------------------- �-F ------------------------------- <br />------- ........... ( ---- ----------------- <br />Alterations and/or recommendations:--------- -------------------------- <br />- ------ 4z V L -A <br />------------ 6 ------------- I . -,L,; -------------- (L-2 ------------------------- <br />--------------------------------------------------------- ­ ----------------------------------------------------------------- --------------------------- --------------------------------------------------------------------- <br />---------- ----------------------- __ ------------------------- -------------------------------------------------------------------------------------------------- ----------------------------------------------------------- <br />------------------------------------------- --------- --------------------------------------------------------------------------- ------------------------------- ------------------------------------------ <br />INSPECTIONBY---------------------------------------------------------------- Date_. --------------------------- --------------------------- <br />130 South American Street <br />Stockton, California <br />ES -9-2M Reviseci 1.57 F.P,CO. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />300 West Oak Street 132 Sycamore Street $14 North "C" Street <br />Lodi, California Manteca, California Tracy, California <br />