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J-LI= <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued --- <br /> Applicai6ion is hereby made to the San Joaquin Local Health District for a Permit to construct and insfall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. 0,?�- 2_(O_� <br /> —7�f <br /> JOB ADDRESS AND LOCATION--- <br /> A- ----- - <br /> Owner's Name____-____. K - 4:,* ----4 ----­ <br /> ----------- --------------------------- -- --------------------- ----------- Phone. <br /> Address.............. <br /> &&:57----------- --.•--------- -- ------------------ - ------ <br /> ---- ---------------------------- ----------- <br /> Contractor's -- ------------------------ - - ------------ Phone <br /> ---------------------- <br /> Installation will serve: Residence ©- arfmenf House [] Commercial [I Trailer Court E] Motel F] Other E] <br /> Number of living units: --- Number of bedrooms ?Number of baths __Z__ Lot size ---�,O_w <br /> Water Supply: Public system-❑ Community system [] .Private a Depth to Wafer Table __10D ff. ------------------ <br /> Character of soil foa depth of 3 feet: Sand El Gravid Ej Sandy Loam El' Clay Loam Ej Clay El Adobe Hardpan <br /> ❑ <br /> Previous Application Made: Yes El No &_New Construction: Yes(29.- No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: -stance from nearest-well-------------____Distance-from foundation___________________Material <br /> Elof compartmen[s------------4-----------Size--------------------------- --------------------------Capacity-------------------------- <br /> Disposal Field: Distance from nearesf.-weP----- Distance from'foundation___._/14._r......Distance to nearest lot <br /> Number of Innes.--------- _ <br /> mat.e a ---------Length of each line-------- ----------.Width of french,----- �a- <br /> Type of 6 1---- of filter material... -Total length-------_t2o__I.!; /_! <br /> ---------- <br /> F ------ ------------------- <br /> Seepage Pit: Distance to nearest well-. QV-_ ___-Distance from foundation---�r . . if -,I <br /> . __.Distance to nearesf lot line--- ---------- <br /> Number ofp;f.s-----/_____________Lining mate ria Size: Diameter___., _ Depth----- <br /> -- - ----------- <br /> ces'pol: Distance from nearest well_________________Distance from foundation.-. _------------ Lining material_-.-_- (�} <br /> ❑ Size: Diameter_________ - ------------- ----Depth--------- --------------------------- <br /> 7 ­­---------------- ----------- --------Liquid Capacity---------------------- gals. <br /> Privy: Distance from nearest well-_.--,.._-._-_ ____--_.-Distance from nearest buifoling------------------------------------------------ <br /> El Distance to nearest-lot line-------- ---------------------------- - <br /> Remodeling and/.or repairing (describe)______________________-------------------- - ----------- <br /> ----------------- <br /> ---------------- -------------------------------- --------- ----------------------------------------------------------------------------I----------------------------------- ------------------------------------- <br /> -----------------------------------------------------------------------------------I--------------­------------- ------------------------a------------ <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, State wfS-Md rules and -regulations of the San Joaquin Local Health District. <br /> (Signed)---- -- ------- - --------------- -- -- <: <br /> 0 <br /> ----------------------------------------------------------- ------------_-------(Owner and/or contractor) <br /> 8 y:--- -----------------------(Tif le)------- <br /> r %_; ;�---------------------- ------------------ <br /> (plot plan, showing size of lot,. location of system in rel6fion to wells, buildings, etc., can be pla'ced bre <br /> side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------- <br /> 'T' Y - ---------- -- ------------- ---------------I-------------------------- DATE----- <br /> REVIEWED BY <br /> --- ------------------- ---------------------------------------------- DATE- <br /> BUILDING PERMIT ISSUED.: ------ -------------------------------------- <br /> ---- -- ------------------------------------------------------------- DATE-------------- 0 <br /> --------------------­--------------------- <br /> Alterations and/or recommendations--- ------- ---- ----------------------- <br /> -------- <br /> -------------- - -----•----------•------•• <br /> ---------------------------- -----------__\j_ ----------- - V ------------- - ------------------------------- ------- <br /> -------------- -- ----.-0------i-e----------------------------------------­------------------------I-- ------------------------------------I--- <br /> -------- <br /> - <br /> ---------------I-------- <br /> ---- ------------------------2--------�--------------- <br /> -------------- -------------- ------•------------------------------------- --------------------------- - <br /> FINAL INSPECTION BY:---- �-- --- ----- - --------- Date....7 . - - - ------------------------------------------- <br /> - <br /> . <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 Tracy, California <br /> ES-9 145446 ATWDOU <br />