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i <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. .- --- <br /> (Complete in Duplicate) 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 /> in compliance with County Ordinance No. 549.€ <br /> This application is made <br /> 1 { Alf <br /> 4 r - r _� <br /> - <br /> j <br /> u � --- <br /> JOB ADDRESS AND LOCATIONw Phone <br /> Owners Name---_ - .�� --------- . .Yr_ - <br /> ----- •----- <br /> ----------------------------------------------------- <br /> Address <br /> ---•-------- ••-----•-----•------•------- <br /> ---•-- Phone---•--••-----=----------•---------• <br /> Contractors Name ---= --- w : , <br /> -- --------•--- --------- -------------------- a e # <br /> .+ ' � � Motel Other ❑ z <br /> Apartment House ❑ Commercial Trailer Court ❑ ❑ 1. <br /> Installation will serve: Residence ❑ p A . 1--.4 <br /> . p 0 4/Lr f1 ----- <br /> Number of living units: sZ__-_ Number of bedrooms *_ Number of baths ..........r o?size -------------- ----- 4 , <br /> �,�./0- Y 0' • De th'to_Water Table t/-- ft. " <br /> Water Supply: Public system E Commuriity system-❑ "Private❑, p 5 , <br /> ` Adobe . Hardpan ❑ <br /> Character of soil to a depth of 3 feet:; Sand ❑ , Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ { <br /> Previous Application Made: Yes El F]No. New Construction: Yes. '] No ❑r FHA/VA: Yes E] No El <br /> TYPE e AND SPECIFICATIONS: <br /> Ou <br /> (NINSTALLATION septictankr' polpifblic.sewer is available within 200 feet.) ' <br /> Septic Tank: Distance from nearest' <br /> resttell - Distance from foundon_,_jfl_______ Material___-____#_,_--__ <br /> No. of compartments--------------------- b <br /> Size__0 -_X---Liquid.depth----�----------------Capacity.-_I-�-- <br /> Disposal Field: Distance 'from near est well' ---t Distance from foundation---)�_____i------Distance to nearest lot line__o _______.- <br /> ..... <br /> Number of lines______-'"'------------ - Len th of each line___.._-®--- -----Width of trench_ ____-_ _`(____----------------••- <br /> 9 <br /> Type of filter material_=�`a�P-- '`---+Depth of filter material___-:)_ - ------Total length__ -4y---------------- <br /> 4, + ' ^' g s__.__.Distance to nearest lot line_________________ <br /> Number of pits---------------.-I-,----Linin material-------------- ------.Size: Diameter-----------------------Depth <br /> Seepage Pit: Distance,to'nearest well_.________, <br /> _Distance from oun a ion___.:- <br /> Cesspool: Distance from nearest-well______________Distance from foundation---------------------Lining material------------------------------------I_ <br /> Li <br /> -Liquid Capacity gals. <br /> Depth q P <br /> Size: Diameter----------------------------- r` p a ----------- - -- -� <br /> Distance from nearest well <br /> k _-Distance from nearest building _ <br /> Privy: _ a _ .c . <br /> ------------- <br /> ID <br /> Distance-to nearest !o#'line"r"'--""�-�-=--"= ------- - } <br /> t I i <br /> x i ' <br /> Remodeling and/or repairing (describe):---"------------- ------------------------------_------------------ -° - --•-----------------•----- <br /> h -------•-------- ---- <br /> - -T <br /> - ------ <br /> i <br /> -----------'-------------------------------'---------------------------•-------------•----'-------------•---•-----'--------- ---_-- ----------------.--._:.. - <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, S to laws, and rules and re ulations of-the San Joaquin Local Health District. i <br /> t =. (Ow Contractor) <br /> (Owner and/or t or) <br /> . • _v = <br /> {Signed) • I <br /> B �--- ---------------••-------------------------------- -------------- -------- -------- -------- <br /> -------------------------------------c. (Title) c d <br /> e_ <br /> (Plot p1a�, showing-size of lot, location of system in relalion'to wells, buildings, etc., can be placed on reverse side. <br /> * FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_� ' _ =------------ <br /> -----------•' °--------------- DATE_ '_�`_1_'` ---------------------------- <br /> REVIEWED By----------------------•---- ----------------r-------- -------- ------ ------ -- <br /> ------------- ----- DATE--------------------------------- ----------------------------- <br /> ISSUE _____•.--------- <br /> BUILDING PERMIT <br /> ------------------------------------------------ DATE------------------------ -----------------------•------ --- <br /> Alterations and/or recommendations------------------------------------------------------------------ -------- <br /> --------------- <br /> -------------•-------- <br /> ---- R <br /> -•------- ----- <br /> 1 <br /> -- --__ -------- <br /> - <br /> 5 <br /> P <br /> FINAL INSPECTION BY:__ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 5 camore Street 814 North "C" Street <br /> 130 South American Street 300 West Oak Street y Tracy, California <br /> Stockton, California <br /> Lodi, California Manteca, California <br /> S <br /> f ES-9-2M ' Revised 1.57 FY.CO. <br />