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FOR OFFICE USE: <br /> c----- -_-_` � r�_ i�� -� - APPLICATION FOR SANITATION PERMIT Permit No. __f .5.... <br /> - (Complete in Duplicate) <br /> -________________ ___ This Permit Ex fires 1 Year From Date Issued )���� 4<jDate Issued .....__._�1..�..�. <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 /> �J ---•--•------------•-••----•------------ ---------------•-•-•-------- <br /> JOB ADDRESS AND LOCATION... .•• --•--------- -- ------------ �� --------- <br /> p q <br /> Owners Name----------------------_��_�...q .- PhoneGl ..� 1 <br /> Address------- I ---•---------------------------------- <br /> Contractor's Name = .� 1'•..... �_.� �---\ ------F ------------------------------•--- --------. Phone----•---------------••----------•-- <br /> Installation will serve: Residence Fr Ap6rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __�___ Number of bedrooms _�._ Number of baths _�___ Lot size _____________r� 02..a. �_-:..__..__ k <br /> Water Supply: Public system ❑ Community system ❑ PrivAte JZ Depth to Water Table . ___ ft. <br /> Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy`Loam ❑ Clay Loam ❑ Clay ❑ Adobe X1 Hardpan ❑ <br /> Previous Application Made: (If yes,date - ____} No [I New Construction: s No ❑ FHA/VA: Yes El No <br /> TYPE OF INSTALLATION AND SPECIFIC ATIONS:#17 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> Septic Tank: Distance from nearest;well_a4oDistance from f undation__fY_._______.__.Material________�`�'--_� �.----__._.. <br /> No. of compartments'._ __-____-._ Vii/ <br /> "'Size .-X� : 1�.3� Liquid depth......_•'�f` Capacity... 4©•�•t <br /> t. t , r <br /> Disposal Field: Distance from nearest,well.pZ00____.._Distance from foundation___J�_ ►h__.Distance to nearest lot line__ .131b <br /> ---------- - -- Length of each lime--------��ri---------Width of french 93"3 I.............Number of lines--_.__--_.'. �} <br /> Type of filter material___S9�4__�W_Depth of filter material------9�_----------Total length_______ _ d______________________ /{T'F <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line-------....... <br /> ... <br /> ❑ Number of pits-------i--------------Lining material------------------------Size: Diameter---------------------- Depth--------------------------------- ($ <br /> Cesspool: Distance from nearest well---------_-------Distance from foundation--------_-----_----.Lining material-------------------------------------- O <br /> ❑ Size: Diameter--------t----------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals, <br /> . I <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------..._.___-__--__.___. <br /> ❑ Distance to nearest lot line---------------------------------------------------------------•-•----- -•-•-•------•-------------------•--------------------------------------g- <br /> Remodeling and/or repairing (describe............. - `' � A�- ------ t <br /> K <br /> = --•--------------------------------------------------- <br /> --�,. � , _ <br /> _______•-____-__-_•____________________________________________________________________________________._ <br /> _________---------_ _ ___ _ ____ _ ________________ ______ ___________________________________ _____________ __________________________________ _________-________ ________ --__. <br /> I Thereby certif have prepared this application and that the work will be done in accordance with San Joaquin County , <br /> ordinances, Stat aw , an ru sand auiations afrthe San Joaquin Local Health District. <br /> (Signed) -�� •Y` ��- --------------------------------•-------------- ------{Owner and/or Contractor) <br /> 8y:. -- ------------------------------ ---------------------------------------------(Title) <br /> (Plot plan, showing size of lot, location of:'system in relation to wells, buildings, etc., can be placed on reverse side). <br /> b FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----------------'= DATE--------•• �f„ <br /> REVIEWED BY -1 f ----------------------- <br /> PERMITISSUED----------------------- '--------------------------------------------------------------------------- DATE------- ------------------------- --------------------------- <br /> Alter�a -o�n a4d/or recommendations::------ --------------------------------------`--------=------=- -•-•---------------------------- .... ------­­---- ----------------------- <br /> - := ¢--`1in 4� " r 7�-�= h`s7� - -------`' 4—�' ``�`--••-------- <br /> �. y.�. <br /> --- 'r .. ....--- est .----- ,L -rr_..:. _ �P rX c-r+ -•--• <br /> -- v--- -------- --_i_ —_-- <br /> //JJJAL l - ------- ---------- Date <br /> ------=-------- <br /> � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Syeamare Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EH-9 REVISED 9•219 r.P.0 A.7M 6.60 - r <br /> 1 <br />