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APPLICATION FOR SANITATION PERMIT Permit No6ori...S� <br /> (Complete in Duplicate) <br /> Date Issued <br /> lica-�ion is hereby made to the San Joaquin Local Health District for a permit 1�1 SP t to construct and install the work herein described. <br /> T application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND_ OCATION <br /> '3„ _6;4---- ------- - • --------- --------------- <br /> Nam ----------------------------- <br /> P <br /> Owner's Nam ...... <br /> Address__ --l—e ------- -------------------------------------------- hone <br /> ------------ <br /> -— ------------- .1------------------------------------- ----------------------------------------------------- <br /> Contractor's Name--- <br /> will serve: Residence ❑ <br /> Apartment House ❑E] Commercial <br /> El Trailer Court F <br /> Motel E] Other rtnVo.,V <br /> Number of living units: ___L__ Number of bedrooms .1--- Number of baths'--/_ Lot size <br /> --------------------- <br /> Wafer Supply: Public"system <br /> Community system El Private El Depth to Water Table <br /> ti Gravel E] Sandy'Loam E] Clay Loam ❑ Clay 0 Adobe Hardpan E] <br /> Character of soil to a depth of 3 feet: Sand'Ej <br /> Previous Application Made': Yes El i NoX` New Construcfion: Yes No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:.ATIONS: <br /> (No septic tank I or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from ne&esr <br /> Distance from foundation__ -----------.Materia.!- -e.-7 <br /> -------------------- '-Liquid dep�h___. <br /> No of compartments_ -i <br /> Capaci fy--------7 <br /> Disposal Field: Distance from nearest well-y-- <br /> Number of lines_____ Distance from foundation---/g/?----:_--Distance to nearest lot line___-----_- <br /> ------------ -------Length of each line___-/JIP ! ---------Width of trench <br /> Type of filter material-, -----/I.-------Depth of filter material /I----------Total length--------/)A_ <br /> ----------- <br /> s nearest lot line------ <br /> Seepage Pit: Distance to near --Distance from" Distance'fo'—" <br /> 19. Number of pits------ -------------/-------------Lining maferiaI_,;evrZ.- <br /> -3 <br /> ze: Diameter---- <br /> De'pth------- <br /> Cesspool: 179!0----------------- <br /> Distance frorn nearest well_____________-----Distance from foundation--- ----------1�_,---Lining material------ <br /> ❑ <br /> - Diameter____-_ I-Depth----- ----------------------- ------ "Liquid Capacity-----------------------------gals. <br /> Size. ------------------ <br /> 7 -------------- <br /> Privy- Distance from-n-ea restyell______________ __----_-_--' I <br /> r. -- --------------------Distance from nearest building-'---------------------------- <br /> El Distance to nearest lot line_____________-------------- -------- <br /> ----------------- --------------- --- ---------------- <br /> Remodeling <br /> ----a--n--d-/or - a i r in �1�6_J <br /> le-): <br /> -- I- .1 -----el ------- <br /> g -/ a ------------ ------------- <br /> -C` ------------- <br /> ------------- --- ------- <br /> --------------------------------- ---------------------------- -------- ---------- <br /> k --------------- --------------------------- ­--------- <br /> -------------iF-------- ----------------------------------------- <br /> ----------f------------•------- ---------------------------------------------------------------- <br /> hereby certify-fha+ I have prepared this'application and that the work will be done in accordance wit---Sart-_Joaquin­County- <br /> ru-,�_ , -------­_­---------------------I--------------------------------------- (Ower Id/or Contractor) <br /> d ru <br /> ordinances, State la I-s 'regulations,of the San Joaquin Local Health District. <br /> (Signed)------ ------ <br /> ---------2r, <br /> By:--------------------- - ._ <br /> __­--- ­ ----- '--------------------------------------------------------------------------(Title)---�_v <br /> (Plot plan, showing size I'of 10 location of system in re:lation to wells. buildings, etc., can belpyel-e"n reve(see sid6j'F;rr_.fir-_.-------- <br /> ------------------ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> ------ ------- ..lee---------------- <br /> REVIEWED BY ------- ---------------------- ---- DATE- <br /> BUILDING PERMIT ISSUED--------- ---------------- --------------------- ---------------------------------­­----- DATE----------------------------............................... <br /> --------------------------- --------- ------------------------------------------ DATE <br /> Alterations and/or <br /> .1 --------------------------------------------------------- <br /> ------------------------- ------ ---------------- ---------------------- ----------------- <br /> ---- <br /> F1 V. <br /> recommendation :---------------- ....... ------------ ----------7--- --------------------------1--------- <br /> -------- -- <br /> -------------------- <br /> --------------!t------t-------1.9----------- <br /> -------------_-, ------------------- <br /> ---2M, <br /> ---------------------------- ----------------------------------------•---------------------- <br /> FINAL"INSPECTION <br /> - -------------- _- ------------------------ -------------- Date <br /> -------------------------------- <br /> --------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street <br /> Stockton, California % ca814 North-"C" Street <br /> Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised W-2100 <br /> jz_ �< <br />