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APPLICATION FOR SANITATION PERMIT Permit No- - ---- ---- ------!P <br /> (Complete". in Duplicate) <br /> Date Issued Ar <br /> A y <br /> egppl�ii'ca-'�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> �s application is made in compliance with County Orcljnylt-p,)No.,�49. described. <br /> JOB ADDRESS VOCATION ------------------ <br /> ----------- <br /> - -------------- <br /> Owner's Na <br /> ------- Phone,' - --- -------- <br /> Addre& <br /> -------------------------- ...... <br /> Contractor's Name________ ......... <br /> -------------------------------------------- Phone_ <br /> Installation will serve: N Residence E] <br /> >. _Apartment House El Commercial El Trailer-Court [:] Motel E] Other <br /> Number of living units. --�-49--Nvmber of bedrooms -<4!,- Number of baths -2-- Lot size <br /> Wafer Supply: Public system', Community system [] Private F] Depth to Water Table -15�ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [-] Clay [I Adobe Hardpan [j <br /> Previous Application Made: Yes ❑ NX New Construction: YNo <br /> OK <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> T <br /> r <br /> tj -- ------------�Ma�e�a ---- <br /> 4----Liqu-i ri i <br /> r11 W e --- is, ce f - - ----- Capacity____----- <br /> SepticAnk: DigInce-2-- nearest we ist ce f I -----------Maferiai­ <br /> Aof partmenfs---- Sizes--- <br /> ts ------------ -- -- ----Liqui --------Capacity----- <br /> r <br /> Disposal Field: Distanco from nearest well--_--------------Distance from foundation----,------------ to nearest lot line.-____'___---- <br /> F-1 Number of lines----------------------------------Length-i5f each line--------------------- -------.Width of trench <br /> Type of filter material_________________________Depth of filter material-L-----------------­Total length__-_________________ <br /> ----------- <br /> Seepage <br /> ength--------------------- ----------- <br /> Seepage Pit: Distance'to nearest well-------lVj)-------Distance from founclation---'­�d---­.-Distance to nearest lot line-/ <br /> Number of pits__!------/­-------Lining material_________JZXZf..Size: Diameter------ ------- Depth----L---------5_4 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------.-Lining material <br /> 1771 Size. Diameter--- -------:--------- <br /> ------------- -------- ----------Depth--------------------------------- ---------------------Liquid Capacity-L--------------------------gals. <br /> Privy: Distance from nearest well----LL-------------------------------------------Distance from nearest building___ ------------------------- <br /> Distance to nearlf�lot,line---------------- <br /> F-1 es <br /> ---------------------------------- ------------- ---- ----------- <br /> ............ ............. <br /> Re Jelin nd r repairing ibe):- <br /> J1 <br /> - ------—-------- --------- ­ ------------------- -------- ----- ------------------ <br /> ----- -- - - --- <br /> I hereby certify that I have prep ed this appIi fion and"t e work will -6-e--done--in accordance w-ifh­San--Joaquin--County <br /> - <br /> ordinances, State and r I s d regulatio e San aquin Local Health District <br /> (Signed)---------- ---- -- -------4---------- -- --- ------------- <br /> and or C tractor] <br /> By------••-- --- <br /> --- ------ ;7-------- ----------------------------------- --------------------------------(Title)- ----- <br /> (Plot plan, sho g size of lot, ovation of system in relation to wells, buildings, etc., can 6" on reverse--si------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------- ....... DATE <br /> ----------------1-456--------------------------------- ------- <br /> REVIEWED BY --------------- <br /> DATE <br /> BUILDING PERMIT ISSUED­ <br /> ------------------ - ---- ------------------------------------------------ <br /> DATE----- <br /> .................................... <br /> Ai+era+ions 6nd/or.recomrnendafio'nsi - �­-T ........... <br /> - -------- ......... -------- ------------ -­----------­-------------- <br /> -------------------------L- <br /> --------------------------------- ------------ <br /> ­----­---------------------- <br /> ... ........ ---------- <br /> Aa,4------ <br /> ----------L---------------------------------------­­--------------- --------------:­-: ----------- ....... <br /> -----------------L-----,---------------------------------------------------------------- <br /> .........& - <br /> -------- -------­----------------------------- -------------- -------- ------ <br /> ----------------------------------------------------------- ---------------------------- ------- ----------------------------------------------------------- ------- <br /> -------------------------- .......... <br /> FINAL INSPECTION57� <br /> BY:-------- ------ A DateL------ <br /> ----------L--------------- <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 /> W <br />