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1 i APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) y / 9 <br /> Date Issued --- s 9 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> I This application is made in compliance with County Ordinance No. 9. <br /> OC ION - -_ __ <br /> HP ----- -- ----- -- --- - -------- <br /> JOB ADDRESS AND <br /> Owner's Name. T c _ Phor <br /> -- --•-•------ ---------------------- --=-- <br /> lr .. .i <br /> Address -,.. <br /> == ----- - ---------------- - ----- <br /> ----- ------ - ---- <br /> Contractor's Name I � ! ---.- A----------------------- Phonit (� <br /> Installation wills e: Residence Apartment Housed]- Commercial ❑ Trailer Court ❑ Motel ❑ O ❑ <br /> h� ill "D <br /> Number of living units:-- Nu er of bedrooms - Number of bath _- Lot size-_..-___.__.__--1` __ _ _ __-____--.._ <br /> Water'5upply:"'Pulili'c'1. <br /> _system" ommunity system"❑`"Private❑-"Depfh #o VV tf r Table,� ft. <br /> Character of soil to a dept I1.f.3 feet: Sand':® 'Gravel ❑ Sandy Loam ❑ Clay Loam _- Clay ❑ Adobe rdpan ❑ <br /> ' —klew'Construcf;k) i <br /> Previous Application Mader Yes ❑ No ❑ ion. Yes ❑ No FHA%VA: Yes ❑ No _ <br />' TYP OF INSTALLATION 'I <br /> AND SPECIFICATIONS: � <br /> ' t(No septicll nk or'cesspool permitted of pubiic"asewer is available within 200 feet.) j <br /> ti Disfanc'from nearest well----------- '_"Distance from foundation- :_-:---�- wf ' <br /> No. of-,compartmenhs- -0-- --- --------- -Size------- ------------------------Liquid cTep#h--"`l`------------------Capacity•- <br /> o al eld: Number sta 'of lines ncE nearest well..._-___` ___IDistance from foundation--------------�_--.Distance to nearest lot line--------,--_-__-- <br /> N ) � <br /> j = Length of each line---------------------- -•iWdth of french----------------------------------- <br /> I Type of!filter)mater'iaL_- - ---­---------------_-- epth of filter material------------------I � <br /> "-Total length----------------------------------------- <br /> 1 R4 <br /> Seepa e Pit: Dista cn e•to�near st)welL_. Dis'tance` rom'foundation-_._�. _{--.Di�ta ce to nearest lo# line­.46-------_ <br /> k <br /> + Nur 60 of pits --------- ----Lining material- _ ' Size: Diameter___-. <br /> Cess ool: Di a L I ir <br /> y1 <br /> ❑ _ - - 1-11 71 1-------------------------- -I----.Lining material----- ----------- <br /> Size: <br /> ----- ----- - <br /> p � nc�, rom nearest ell_---_I_.___-----_Distance fro foundation--------------- <br /> S�ze: f}iameter-------- --- ---= - -Liquid Capacity-- ------------------'--gals. � <br /> Privy: Distance from nearest well--____-_--_-.--_--_-w_ .._ _______-----------Distance from nearest`b0clin __-----_----_-, <br /> #ante to nearest lot lire______________________ _--__ __ <br /> El iso -.1 --------•------------------------ <br /> Remodeling and/or repairing {describ. ---------- --. ---- --- ---� -------_- -- <br /> ----------------------------- ------=----------------------------- -------------- <br /> I <br /> ----------------------------------- <br /> I here by-certify`that1"1 ave'prepared-this-appiication-and-that`fhe work will-be-don n accordance with San Joaquin County <br /> ordinaPshowingg <br /> , and$'ides and re lations of the San Joaquin Lo alth Di ict, i <br /> II � � a <br /> p 1 --- -------------------- <br /> Contractor) <br /> (Signed) ;JJ= <br /> ------. a------------------------ �-sir` --- (Title}- <br /> ---- - -------------------------------------------------------------- <br /> (Plot pe fof lob, location of syst mein' relati Is uildings, c., can be placed on reverse side). <br /> it NI� FOR ifEPARTMENT USE ONLY r <br /> APPLICATION ACCEPTED BY--- i- -",'r _ <br /> I� - ------------------ DATE ----------•------------------------------- <br /> REVIEWED BY ----------- ---------------------- DATE <br /> BUILDING PERMIT ISSUED_)11------------------------------ � r -- v <br /> DATE - <br /> Alterations and/or recommendations------------------------------------------------------•-•--•-------------------------------------- <br /> ------------------------------------------------ <br /> -------=----- ------ <br /> - ---- ------------------- <br /> = <br /> --------- <br /> ---------------0------------------- <br /> A - - - - - --- ---A- ?-- <br /> -- <br /> ---- -------- 'v im_---'------ �-- - --- <br /> i-- -- ---------- <br /> �+ _ '� <br /> ------------- <br /> -----'--- -- ---------------- <br /> FINAL INSPECTIOW BYJ-- Date �--4 -r - <br /> f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soefh American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef <br /> Sfockton, California Lodi, California Manfeca, California Tracy, California <br /> ES-9-2M ltevisea 1.57 FY.co. <br /> 'IN! I <br />