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ya <br /> APPLICATION FOR SANITATION PERMIT Permit No. q1 <br /> (Complete in Duplicate) Date Issued A.7-_N1 <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. 3- 2--f 0 <br /> �o <br /> JOB1ADDRESS AND LOC ATION----A <br /> IV a� <br /> T - - -- ------------------------------------ ---- -- - -------- Phone--- <br /> Owner's Name-------- -Y) --------L.__ 9--- <br /> -------- ---_.- - <br /> Address------------ 4�+_---1------ ----------- ---------��4:-------------------------------------------------------------------------------- <br /> Contractor's Name------------------1 ----y----- ------- ----------- ------ Phone--------------------------------- <br /> Installation will serve- Residence'®` Apartment House E] Commercial E] Trailer Court El Motel El Other El <br /> Number of living units: _1____ Number of bedrooms ---2--"Number of baths J--- Lot size j 7_-----C/T(-------------------------------- <br /> Wafer Supply: Public system El Community system X Private El Depth'+o Water Table -------- ft. <br /> Character of soil to a depth of 3 feet.- Sand E] Gravel E] S�'ncly Loam E]''. Clay Loam E] Clay 0 Adobe HardpanLSI <br /> Previous Application Made: Yes [:1 1\10)� New Construction: Yes�s( No E] FHA/.VA:.Yes E) 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_ __Distance from foundation---/A----------Material----- 4 --------- <br /> �Y- <br /> No. of compartments- - - ----------- _:__-Liquid deptk-------q---------------Eapac 6o--------- <br /> Dis I Field: Distance from nearest well_)-UQ&-t_Distance from foundation---A0-------.-.Distance to nearest lot line_,Ir------- <br /> Number of lines__________ ------Length of each line____ -41----Width of trench---- <br /> ---------- <br /> -- --------- <br /> --------- -----/ <br /> Type of filter material------1� ----------Depth of filter mate-rial--------il---------Total length__ ____. ` <br /> SeepagePit: Distance to nearest well_-------------------Distance from foundation--------------------Distance to nearest lot line___________-_____ <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter---------_-------------Depth----------- --------------------- <br /> Cesspool: <br /> epth------ ---- --------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-,.----------------Lining material_____-_____________._______________ <br /> E❑-1 - Diameter---- :------------ ---------------------------------------------Liquid Capacity-----------------------------gals. <br /> Size: imefer---- -------------------- Depth------ <br /> Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> F1Distance to nearest lot line-----------------------------r---------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------I—'.............--1-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- <br /> --------------------------------------------------------------------------I-------------- ------------------------------------------------------------------------------------------------------------------------- <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 law , and rules and rejgul ions of th <br /> (Signed)--4— the an Joaquin Local Health District. <br /> -tor)-------- --- - ------------------- -------------- ---------------------------------------------------------------------------------(Owner and/or Contractor] <br /> By:---------------------------- ----------------------------------------- ----------------------------------------------(Title)--------------------------------------------------------- ---- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> Y <br /> APPLICATION ACCEPTED BY IL� - - --- <br /> -------------------------------------------------------------- <br /> ------ <br /> DATE - --- - ----------------- <br /> REVIEWED BY - ---------------------------------------- ------------------ --------------------------------- DATE------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------_---------------------------------------------------------- DATE-------------- ---------------------------------------------- <br /> Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------------------I------------------------------------ <br /> -----------------------------------------------------------------------------­­--------------------- ----------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- <br /> ----------I- --------------I-------I----- --------------------------------- ----------------__-------------------------------------------- ----------------------------------------------------------------------------- <br /> • <br /> FINAL INSPECTION BY,1447-,7�_ W-------------------- Date---- -------- ----------------------------------------- <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-9-2M Revisea 1-57 FY.CO. <br /> L <br />