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APPLICATION FOR SANITATION PERMIT Permit No. ... �1�---__ <br /> olete in Duplicate) / / r <br /> . <br /> (Complete P, � Date Issued ----�/���--- <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 54-9 <br /> JOB ADDRESS AND A 10 --------- -------------- �J =. :..� f, Y` -------------------------------- -------------------- <br /> Owner's Name---- --- ---- ------ -1----- �� -''` Phone <br /> Address-----�.. /_1.------ --------3----•-•-------/---------------------------------------------------------------�----------------......-------------------------------------------------------------- <br /> Contractor's Dame..............______ f - _ - ,------ Phone., --- <br /> Installation will serve: Residence <br /> /❑ Apartment ouseX Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 6,1--- Numberof bedrooms _fz _ Number of baths <br /> Lot size���- �+����------------------------ <br /> t � <br /> Water Supply: Public system Community system 0 Private ❑ Depth to Water Tably/C--� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑' Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay E] Adob� Hardpan E]Previous Application Made: Yes ❑ No �ew Construction: YesX No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if.public sewer is available within 200 fee+.) f <br /> Septic Tank; Distance from nearest <br /> Dispos- field: well from foundatiMaterial--------- <br /> No. of compartments--------------------------Size-----------_.-_._ Liquid depth_ Capacity____--..__."___ <br /> Distance <br /> from nearest well_________--..._Distance from foundation__-.-__-__."___-".__Distance to nearest lot line----------------- <br /> jf , Number of lines----------------------------T--- -Length of each line-------------------- <br /> ----------Width of french----------------------------------- <br /> / Type of filter material------ ------------------Depth of filter material-----------------------Total length------------------------------------------ <br /> f <br /> --.--------------------------.---- ---- <br /> Seeps ePit: Distance to nearest well ext- _.___Distance f.orn foundation----- Distance to nearest I line_:__��___ ... <br /> __Linin material - -� ._ .Size: Diameter___��+_ De th-..- � --77 _ <br /> Number of pits 9 w:--- x._ p v� R"rJ-�� <br /> Cesspool: Distance from nearest well_:-_---.__."__-Distance from foundation--"-----------------Lining material----------------------._ <br /> ❑ Size: Diameter---------------------------------°-'-Depth--------------------- -----------------------------Liquid Capacity-------------:-------------gals. <br /> Privy- Distance from nearest well -"-._.--.._-_-------------------------------- _Distance from nearest building----------------__-._-_-_-----..--_._____. r <br /> ❑ Distance to nearest lot <br /> line--------------------------------- - -- -------------------- ------ -----------------------------�---------------------------------------- <br /> inanor reairindescribeRemodel -------------• <br /> -- ---------------/------- ---------------------------------------------- ---------------------------------------------------------------- <br /> WV <br /> ' "- ---------------------------------------------------------------------------­--------------------------------------------------------------------------- <br /> ---------- `--------- ---------------------------------------------------------­­----------------------------------------------------------------------------11--------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance$, State laws, an rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----------- ----;� ------ ...--=-=-------'-- _.----------------- ---------- - ----------------------------------- - -----{-------�_------ - -- - <br /> Owner and/or Contractor <br /> (Owner ) <br /> �Y� + -••---=� = ---------------- Ti+le _. '?: - �� <br /> (Plot plan, showing size of lot, [oca+ion of system in relation #o wells, buildings, a+c., can be placed on reve a side) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ " <br /> =--- DATE-------- --� r <br /> REVIEWEDBY----------------------------------------------- - ------ ---------------- ---- ------------------ ---------------. DATE------ ------•-------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------- -------------------------------•--------------------------------------- DATE-------------•-----••----•---------------------------------- <br /> Alterationsand/or recommendations:-.-.----------- ------------------------------------------------------------------- -----------------------------------•------------------------••-----• ------ <br /> ----------------------------------- <br /> ----- <br /> �....,�� -- ------- ------ <br /> ----------------------------- <br /> r <br /> {:r <br /> --_ �� ...____. _......__._ <br /> ______'__ __ }J .� <br /> , j.• 1.ef, � f�''�•F.-�� -,.1�* �'Y'�• __�`i7P�-,_-(�{f��.�R_ 'f t:�_=� ��_: ''�-,_,�_._ 'V9 ___''�' __`_____�_1"�__�_ _ <br /> t <br /> = <br /> - - ----- ---------- --- <br />� k <br /> FINAL INSPECTION BY:_._..____.__.--"--- T <br /> = 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 Revised W-2100 <br />