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APPLICATION ' FOR SANITATION PERMIT Permit No. .__. _+'_.G -" <br /> (Complete in Duplicate) r <br /> _Date Issued --- 1 ` 5:--7• <br /> Applica4-ion 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. ? E <br /> JOB ADDRESS AND OCATION.______ r <br /> ------ --- - ----------- --- ------ <br /> _ . _ <br /> -�Owner's Name-'--6p - -------------------------- <br /> ---------------------------------------- <br /> --------------------- <br /> ---------------------------------•----- <br /> ---------r--------- Phone--------------- <br /> :Address-------- <br /> ,_ z T <br /> Contractor's Name____________ _ R <br /> Phone/ <br /> --------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court <br /> ❑- Motel ❑ Other <br /> Number of living units: Number of'bedrooms ❑ <br /> Water Supply: 'Public system t --------------- <br /> �"lNumber�of'ba hs _"___ L`o�size _ <br /> y 1❑" Community system,❑ Private Depth to Wafer`Table,lS__ {t, <br /> Character of soil to a depth of 3 feet: San !.I I <br /> 1 I, ❑ Gravel ❑�'S `dy;.L oam❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes No f' <br /> ❑ ' i New Construction: Yes ❑ No� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - `- <br /> (No septic tank'or cesspool perrrti4ed if public sewer is available within 200 feet.} t <br /> Se a k: Distance f 1pm nearest-well es�weil_____".______._--Distance from foundation_.__--- --.Materia!___""-- "--__-----_-- <br /> No. of core artments____".._."_.._ ----�- - <br /> --••• <br /> ----------Size-•-----------•------------"'.'1Liquid depth---- � ------------Capacity P tY ---------------- <br /> D" dal Fiel : Distance from nearest-well-----------------Distance from foundation-----------____`-----Distance to nearest lot line.__________.___.. <br /> Number of lines------'-------------------------- Length of each line-- ------------------------- <br /> Type or filter material--------------- Width of trench_.--_____---"___--_----- <br /> p I I `_ Total length___-. --------------------- <br /> e t o filter matJ. er'ial___-.____ <br /> ....... <br /> Seepage Rif: Distance to nearest well_ -�___"--.___"_Distance f m f und5 ze:nbia ' � / <br /> 3 --"_-- Distance to nearest e._�_ <br /> Number of pits_____-- I Linin material----� y ryt. �}� i� <br /> { g --- - meter -ZE , <br /> Det J ' p • <br /> Cesspool: Distance from nearest well_______ _________Distance from foundation_____.- _' <br /> ----Lining material------------------------------" <br /> ❑ Size: Diameter-------------------- - --------Depth----------------- I <br /> t --------------- ------ --- Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well ' C, <br /> ---------------------Distance from nearest building------------------------------------------ <br /> ..........Distance to nearest lot fine_-._.- r:� ��• "---_ ."" -� __ .. ----•-------- <br /> ------------- ------------1.v <br /> Remodeling and/or repairing (describe):___ ____._`"_ _ ! <br /> - ----------------------------r..- _ <br /> d ' - -- ------------------ ------- <br /> -----------------------------------------=------ ------•------------------------I <br /> _._______-4___-_-__ - I _ ________________________________________________________ <br /> ---------------------­----_____________________- ..____--___._______ ------------------------____..i..---._--__......... <br /> -- p Pp _ <br /> . r I = --------------}--------••-----n ... - <br /> ordinances,!re ala shandhrule andar guiatons ofcthe San Joaquin the wt fw'ill be done in accordance with San Joaquin County <br /> q Health District. <br /> (Signed) .. <br /> 1 �. <br /> 9 -------- ----------- ---- •-------- ------------------------------------------- ��------�--(Owner and/or Contractor) <br /> •- <br /> By:---------------------- ----- <br /> - ----- - -----=-----------=------------------- ------(Title)_-- -- <br /> ------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc., can 6e.placed on reverse side). <br /> a , FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------- --- ----------------- <br /> bATE. ---•------------ <br /> -- ---- -------------------------------------------------------------- DATE- <br /> BUILDING PERMIT ISSUED-------------- i <br /> D.ATE-------- <br /> Alterations and/or recommendations:____-_.______- <br /> --- <br /> -------------------- ------- r ------------- <br /> -------------------_-- <br /> --- - --------- - <br /> FINAL- INSPECTION <br /> ------- bate.... - = - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street. 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California <br /> Tracy, California <br /> ES-9-2M Revised W-2100 <br />