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APPLICATION FOR SANITATION PERMIT <br /> Permit No. __.-_-- ----� -f7 <br /> (Compiete in Duplicate) / (� <br /> Date Issued .__.__ --,�"3 <br /> L/ <br /> 4 Application is hereby made to the San Joaquin Local Health District for a permit to co str and install the work herein described. <br /> This application is made in ncompliance with County Ordinance No. 549. <br /> 77-f� — '~ - ----•--------------- <br /> OB ADDRESS ALLOCATION:44 '--- ---�- '�'---1 <br /> Ph one <br /> •- 1 � �,?'�`/�s` <br /> - <br /> ------------------------------------ <br /> � --•--------•------------- •----------•---------• ----- ---------•----------•------------------ <br /> --- ----------- --------------- <br /> Owner's Name-- �p .._Address_ � <br /> Phone----------------------------------- <br /> - - ---- <br /> Contractor's Name__/r'c- ---•--- --------- -•- <br /> Commercial Trailer Court [j Motel ❑ Other <br /> Installation will serve: Residence Apartment House ❑ ❑ <br /> Number of living units: -1------ Number of bedrooms Number of baths -1----- Lot size --- <br /> Water Supply: Public system F1 Community ❑ Depth to Water Table .__.-___ ft.Community system ❑ Adobe El Hardpan 11Character of soil to a depth of 3 feet:. Sand ❑ Gravel El Sandy Loam ❑ Clay Loam M Clay F1 <br /> Previous Application Made: Yes ❑ No. New Construction: Yes"M 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___tA- Distan e from foundation_--_ --------.Material_. <br /> 4A^ Size---_'t S"• { -----------Liquid depth------Y----- - ---------Capacity_ > -- -------- <br /> No. of compartments---------------------- <br /> r <br /> r of • <br /> Disposal Field: Distance from nearest weil..,��--------.Distance from found to nearest lot <br /> Widt <br /> Number of line ---------------- -- Length of each line-------------U,--------Total filen length-- ----------- <br /> ------------ <br /> --De Depth of filter material___ ___________________ 9 <br /> Type of filter materia!_- --------- - p <br /> Seepage Pit: Distance to nearest well------------------- from foundation--------.-----------Distance to nearest lot line--------------------- <br /> ------- <br /> Number of pits----------------------Lining material.----- ----------------Size: Diameter------------- Qeptn <br /> Cesspool: Distance from nearest well _Dista nce from foundation---_----------------Lining material-------- ------------------a---- <br /> �Size: Diameter-----------------•-------------------.Depth----------------------------------------------------Liquid Capacity-.---- -------------9 <br /> ❑ Distance from nearest building--------------------------------------- <br /> Privy: Distance from nearest well ------- --------------- <br /> ❑ Distance to nearest lot line-------------------------­-­------------------------------- <br /> Remodeling and/or repairing (describe):--------------- --------- ---- <br /> ------------- <br /> •------------•------------------------------------------ <br /> --------------------------... --------- <br /> ----- ------------- <br /> ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, to a laws, and rules d rSqulatio6is of the San Joaquin Local Health District. <br /> ------------------------------------------------------------(Owner and/or Contractor) <br /> - <br /> Title <br /> ---------------------------------------------------------------- <br /> ---------- ------------------------ <br /> --------- <br /> - <br /> F (Plot pi;�n�,� owing 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 /> ------------------------------------ <br /> DATE__/O-_:-_277'�3---------------------------- <br /> REVIEWED BY----------------------- ------------- <br /> ------------ ----------•--- DATE------ ----------------------------------------------- --- <br /> ----------------- --------- DAT --------•:------- •----------------------- - ----------- -- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------- Y ---•---- -- ----------------- <br /> --- -------------------------- <br /> Alterations and/or recommendations-------------------------------------------- <br /> ----------------- <br /> " Date. <br /> / 3 <br /> FINAL INSPECTION BY:_.- ----- - --------- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street <br /> 132 Sycamore Street 814 North "G" Street <br /> 13o South American Street TracCalifornia <br /> Stockton, California <br /> Lodi, California Manteca, California y <br /> ES-9-2M 10-52 Revised W-2100 <br />