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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate)a) Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install A work herein described. <br /> Ordinance o. <br /> This application is made in compliance with County OrdiN549. <br /> ) <br /> �g 46 <br /> JOB ADDRESS AND LOCATION/0'6_'.1;'4 Yql_ <br /> Owner's Name___ <br /> .6-------- ------- --------------------- Phone------ <br /> Address----------------------------•- <br /> hone------ <br /> Address------------------------------ V <br /> Contractor's Name___ - -------- <br /> ----------------------------------I--------------------------------------------- <br /> Phone <br /> Apartment House E] Commercial E] Trailer Court----- Lot size ---- —-----10_—O__XsY�10 M tel 0 Other <br /> -----n- <br /> ❑ <br /> ce <br /> Installation will serve: Reside -------------- ----------------------------------- <br /> - <br /> Number of living units: __l___ Number of bedrooms -3--- Number of baths / x <br /> Water Supply: Public system E] Community system E] Private [v/Depth to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand El Gravel [] Sandy Loam E] Clay Loam E] Clay Ej Adobe 0 Hardpan E] <br /> Previous Application Made: Yes E] No RNew Construction: Yes E-1 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No/septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se ; <br /> (No <br /> Distance from nearest well___10�1?1-----Distance from foundation /0 <br /> pV No. of compartments-------- ----- ------------------ <br /> Maxtial <br /> i�-------------- <br /> -------Size... ___-___Liquid depth__________-'-- _0------ <br /> Disp;�Ielcl: Distance from nearest well... .-Distance from foundation.-.--/U/O---------Distance to nearest lot line-- 1!5-'( <br /> r line__.-�__-__ <br /> Number 0 1 lines______ --- -----Length of each line__________ Width of trench. �2-��' <br /> 40 It-------------- <br /> length------------------------------------------ <br /> Type of filter material-­ Z42—mDepth of filter material------------). --------- <br /> SeeRa e Pit: Distance to nearest well------ ------Distance from foundation---------- D-stance to nearest lot line <br /> ---------- ' <br /> "jfj,4�� Number of pits----------------------Lining material-----------------------Size: Diameter--------_-------- ---Depth----------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_________-_.--._____.__ <br /> ❑ <br /> aterial----------- ----------- <br /> El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity- ------------------- <br /> Privy- Distance from nearest well-------------------------------------------------Distance from nearest building._____--,____._.__________._. <br /> ❑ <br /> uilding.---- <br /> F-I Distance to nearest lot line <br /> Remodeling and/or repairing (describe):-------------------------------------------------------------------------- -------- ----------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------;�-------- <br /> ----------------------------I--------------------------------------------------------------7--------------------*-----------------------------------------------------------------------*---------------------------- <br /> -------------------------------------------------------------------------------------------------------------- -------------I------------------------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou <br /> ordinances St fe laws, and rules aid regulations of the San Joaquin Local Health District. <br /> (Signed)__'�XT.:T_, - -------------------------------------- -- --- -------(Owner and/or Contract <br /> �r -------------------------(Title)-- ------------------------- - <br /> By:_------------------ -------------------------------------------------------------------------------------------------------- <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 /> APPLICATION ACCEPTED BY <br /> REVIEWED BY-------------------- --------P0�w------------------------------------------ DATE------------ -------- <br /> ---------------------------------------------------------------- - ------------ DATE------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------- ----- DAT <br /> Alterations and/or --------------- <br /> -----------------I--------------------------- -------------- ---------------- -------- <br /> 242- <br /> ------------- -W.4 , -C, f V^ I- <br /> L --------------- ------ -------------- --------------- 4.... -------- <br /> ---------------------------------------------- --------------- -------- --- - ---------- <br /> ---------------- - - - ------------ <br /> ----------­----------- ........ -- ----- --------- -------------------- -------------------------------------- <br /> --------------1------------ 1.K-------------------------------- ------------------- ----------------------_-- ---- ----------------------------------- ---------------I---------- <br /> FINAL 'INS,PECTION BY:----------------------------------------- --------------------- ------ ---------------------- - ------------------------------------------------ <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 F0-52 Revised W-2100 <br />