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9 APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <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 � <br /> compliance with County Ordinance No. 54/9. <br /> JOB ADDRESS AND LOCATION_ ce,.3-_ r`- <br /> 0X--. �_7t..'_LTL_-_ _/-.-/ __ `__.`___�171 )A AI------ A/,•.3- - <br /> I�Se, —PASS GAA VOb)7 4E-C RO-Z L,� Yal _14t L A46 IV ►-eco � <br /> Owner's Nair <br /> a ------ -------- Pone---&- -- � <br /> - -- - ---- --------------- ------------------------------- ' <br /> Address r -1--C--f----aZ�l���-.G���'---------•--------•------------•---- <br /> Contractor'se -------- _t -_��-WY2��' <br /> � ?- /-!_Vt.��--------------- --------- Phone---- ----------------------------- <br /> Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑` Other ❑ <br /> Number of living units: &W—Number of bedrooms _Number of baths -------- Lot size ._�_a__X---1.50--------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private 4 Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay❑ Adobe [❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No)Z New Construction: Yes ❑ No K_ FHA/VA: Yes ❑ 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---------------------Material_____-__-_____.___._____--___-_____.._______... <br /> ❑ t1S-hNo. of compartments---------- --- -----------Size--------------------------------Liuid de th----------------- --Capacity <br /> Disposal Fiefcl: Distance from nearest well-----------------Distance from foundation-__________-_____Distance to nearest lot line----------------- <br /> ❑,�X1SfrKe Number of lines-----------------------------------Length of each line-----------------------------Width of french----------------------------------- <br /> Type of filter material___._ ________Depth of filter material-----------------------Total length----------------------.------------------- <br /> � <br /> Seepage Pit: Distance to nearest well-1-66-f_______Distance from foundation_____I----. i .,qpce to nearestNot <br /> Number of pits___ (.,e___-___Lining materialRM_h-K4_.Size: Diameter____ _ ____________.Depth � ---------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material --__Z_Q----- ._ _ _ _ _ <br /> ❑ Size: Diameter--------------------------------------Depth ----- -------------------------------------- __Li quid Capacity- ---------------------- --gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________.___________-------__-------_--- <br /> ❑ Distance to nearest lot line -------- ----------- ------------------------ --------------------------------------------------------------------- <br /> Remodeling and/or repairing [describe]-------- ------ - 44 -f _� --�( - ------- �L- - -.ri ------------•----------------- <br /> ------------------------------------------------------------------------------ <br /> -------------------------------------------------------- <br /> -----------------------------------------------------------•-•-•---------------•------•---•--------•---------••---•-------------------------------------------------------------------------•--------------------------------- <br /> I hereby certify that I have prep ed this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat laws, and rules dd gulatio s of the San J�)uin Local Health District. <br /> [Signed}.._...... ----- -------- � � t `� (Ownoer nd/or Cantractorl <br /> -Az_ <br /> ---- (.Lf- -- Title <br /> 8y:. (Title)--.--i r--�1.__ ! - ----------.. <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-- ----- ---------------------------------------------------------------------------------- DATE-::,, ---•-••---------------------------------•----------- <br /> REVIEWEDBY----------------------------- t ------------------------------- - ---- •---------------------------------------- DATE___L,54 ---------------------------­----••-------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------- ------------------------------------------------- <br /> Alterationsand/or recommend ations---------------------------------------------------------------------------------------.--------------_--------------------------------------------------------- <br /> ----------------- <br /> ------ - --- -- Cl �' F ' 1 -'6 f.t,a ' �. <br /> iL <br /> 1_'J---- ---------------------- -- --------------------------------------•-•-•-----1- <br /> 0 <br /> - - ------------ <br /> -------------------- ------------------- ----- - ----------------------- ----- ---------- ---------------•-•---•--------------------------------------- ------------ ---------------------------------- -------- <br /> J0 <br /> FINAL INSPECTION BY:--------- = ----------------------- Date-----1_ -----------3 -. 1 <br /> - SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Stree+ 132 Sycamore Street 914 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9---2M Revised 1.57 F.P,CO. <br />