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APPLICATION - - <br /> FOR SANITATION PERMIT Perm;t No. _ �qr <br /> _r-( <br /> ' (Complete in Duplicate) <br /> y Date issued `42 <br /> Application is hereb -Sz <br /> ------- --�J <br /> y made-to the San Joaquin Local Health District for a permit to construct and install the work here, described. <br /> This application is made'in compliance with Cou Ordinance No. 549 <br /> JJOB ADDRESS A LOCATIO C:-§- 9 `� <br /> Owner's Na a----- - - <br /> -------•----------- - --- <br /> - Phone- <br /> Address C�► <br /> ----- --_�--_ ------�. <br /> - ---------- <br /> Contractor's Name- -------••------------- -- <br /> -= -•-- -----•--------------------------•---•-- <br /> nstallation will serve:` Residence Apartment House CommercialPhone----------------------- <br /> ❑ Trailer Court E] Mofel <br /> •� Number of living units: -�- Number o{ bedrooms .- _---, pp / ❑ Other ❑ <br /> Numbe�Dpfh <br /> afhs .1_ Lot size -1 <br /> Water Supply: Publics stem <br /> Y ❑ Community system --------------------------------- <br /> 1: Y Y Private to Water Table -------- ft. <br /> Character of soil to a depth of 3 fet: Sand Gravel E] Sandy Loam Clay Loam Clay <br /> Previous Application Made: YesConstruction: <br /> � Y Y ❑ '°`dobe Hardpan ❑ <br /> ❑ No 11� New Construction: Yes 54 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ <br /> (No septic tank or cesspool permitted if publi sewer 's available within 200 feet.]1 <br /> Se tic ank: istan er <br /> p Distance from nearest well l� <br /> No. of compartments-. n--- <br /> Z A-----p_Si <br /> x�jl� <br /> tion-----------------Liquid depth--. ---------------4.4-1.111_64 <br /> Capacity /D <br /> Dispos Field: Distance from nearest w ll / nn <br /> r istance from foundation.! Y � <br /> l . �7Jistance to nearest lot lin A_Yp - ---- <br /> um er of lines.--._- -- - Length of each line--------- -- - - <br /> �- Width of french... <br /> _r <br /> r er -�epth of filfier material_--__� Total length------_--- <br /> Seepage Pit: Distance f toenearaes # <br /> rt well_______________ _____D;stance from foundation-------------------- �-�------ --_-------•---- <br /> ❑ Number of pits---- ----------------Lining material---- Distance to nearest lot line-------------- <br /> --------------------- <br /> -------Size: Diameter-------------- - __Depth--------------- <br /> Cesspool: Distance from nearest well------------- <br /> . -----------------Distance from foundation--------------------Lining material_--_--_--_--__________ <br /> ❑ Size: Diameter.-----]----------- ------Depth----- " <br /> -----Liquid Capacity---- ---- <br /> Privy: Distance from nearest well-- _._____-_ gals. <br /> f --------------------Distance from nearest building_---_-__---- <br /> ❑ Distance to nearest lot line.-.__________________ ___ -._------_--_---_-._ <br /> ---------------------------------------•--- ----------------------------------------Remode!1N, and%or r airing (describe)------------------------- <br /> ) <br /> _-----_-------------•-------------------------------------------•------------------------------------------------------------•--------•-------- --------------------------- <br /> ------------- ( rr <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, St law ;:and rules and r`e ulations of the San Joaquin Local Health District. <br /> _01 re <br /> By:': <br /> ----- ----------(Owner and/or Contractor <br /> { = 9 -; - -=----------------------------------------------------------------------Title <br /> ( Plan,y of system in relation to wells, buildings, etc., canbe ]laced on <br /> -------------------- <br /> of showm size of !o+ location _ <br /> P reverse side). r <br /> } x FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED,B -- <br /> F ------------------------------- DATE <br /> REVIEWED BY________________ <br /> BUILDING PERMIT ISSUED-. --------------------------- ------------------------------------------- DATE-_ L"a <br /> Alterations and/or recommendations:--_:-'._ DATE--.-----. <br /> ---------"------------------•------------ •---------------------------------------- ----.----- <br /> -•-------- <br /> ---•- <br /> � L <br /> � �� > - <br /> .- <br /> FINAL INSPECTION BY:.. _---___: r- W <br /> .--•-F---------------------------------------- Date---------- <br /> ------------------------------------ <br /> SAN <br /> --- ----------------------SAN JOAQUIN LOCAL HEALTH-DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> Stockton, California 132 Sycamore Street 814 North "C" Street <br /> Lodi, California Manteca, California <br /> Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />