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Permit No. <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and installthe work herein described. <br /> This application is made in compliance with County Ordinance No. 549. go I <br /> JOB ADDRESS ANDOCATION------- ----------------- <br /> ---5---RA----- <br /> ----- Phone <br /> Owner's Name----------t$2�d ------- .- <br /> AddreAddress----------------------- <br /> ss----------------------- --------- ------ --------------------------------------------------------------------- <br /> Contractor's Name--------- ---------------------------------------------------------------------------------------------------- Phone------------------------------------ <br /> 1 0 Ofh <br /> Installation will serve: Residence House ercia n Trailer, �--oqrt�E]_. Mctfe . er. <br /> p� ,_qse D 'Comm. 'I . - -e-�-67)11 <br /> Number-of baths -1----- Lot size.-- ------------ <br /> Number�of living units:--.]---- Number of bedrooms <br /> X 'r --- <br /> Water Supply: Public system 0 Community system El Private Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand F-1 Gravel n Sandy Loam E] Clay Loam El Clay Adobe x Hardpan <br /> ❑ <br /> Previous Application Made: Yes Ej No New Construction: Yes No Ej <br /> K <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee}] 1 <br /> Tank: Distance from nearest well-11k,5- is an f r qund ion------74-------Mate ical 7 <br /> ---------------------- <br /> Se <br /> -------------------------------------------- <br /> -------------Capacity-11-0-0--- ---- <br /> No. of compartments--------- --------- -X Liquid �eptb <br /> P91, <br /> *S ents--------- -- ----- <br /> '1100---- ize-- d Distance to nearest lot Une-s$�� <br /> Disposal Field: Distance from nearest well---11-------------Distance from foun a lot- -------- --- <br /> Number of lines-- -------Length of each line----. tpidth of trench_-t------ -- ---- --- -- <br /> fe-rj­a�--�� A ---Total length___.% -t----- <br /> --- Depth of material -- <br /> Type of filter ma - ---t n Distance to nearest lot line----------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from founclafio <br /> Number o� pits----------------------Lining Lining material-----------------------Size: Diameter------------------------Depth------------------------------------- <br /> o umfrom foundation--------------------Lining material__________--_______-__________---__-.Distance from nearest well____________ Distance Capacity---------------------------- gals. <br /> -------Depth----------------------------------------------------Liquid .. <br /> Si❑ ze: Diameter_ <br /> A�ance fro-��-n`earest building------------------------------------------ <br /> -=ti-stance from nea�ret-;jll well___ -—--------------- ------------------ <br /> Privy: ---------------------------------------- <br /> �a 11, <br /> ❑ Distance to nearest lot line________._-____----------------- ------------------------------------------------------------------ <br /> t 4 <br /> ----------- <br /> ---------- <br /> Nt /&------- -------- - --------Remod&g and/or repairin (des 'be):__ --0------1� <br /> _4 <br /> ------- ...... <br /> -- ------------ ------- ------------ <br /> in <br /> --- ------------------- - - <br /> --------------V---L ---- ------------C,-- ----------- ------- ccor4a- <br /> ---------- k will be accordance application and th the r one I ordange with San Joaquin County <br /> I hereby certify-tha I have prepared this <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed).-A�:r:��rn�v----- ---------------------------(Owner and/or Contractor] <br /> 01 ---------------------------------------(Title)---------------------------------------------------------------- <br /> By:-------------------------------------------------------------------------------------------- buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot, location of system in relation to wells, <br /> F DTPARTMENT USE ONLY <br /> DATE------. ----------------------- <br /> APPLICATION ACCEPTED BY-------------- ---------------------------------------------------------------- <br /> DATE--------------------------- <br /> REVIEWED <br /> ATE--------------------------- --------- <br /> ------------------------------------ <br /> REVIEWEDBY------------------------------- ---------------------------------------- <br /> ,-.B.U-I;LDlN-G4PEP,MJT-]S.S.U,ED---------------- --------=- <br /> ..... --4A <br /> Altqrat* d/or recommend a fi9r)s:---T V4- <br /> ,.�4n a - ---------------------- <br /> -A---- <br /> --- ------ ------ <br /> ------------ - .. ---?- - ----------------------------------------------------------------------------------------------- --------- ------------ <br /> --------- ------------- r. --— --e-- r-� ----------------------------------- <br /> -------------- .,�------ - -------------------------------------------------------------------------- <br /> - ---------------------- -— ------------ <br /> FINAL INSPECTION BY:______._---- --------- ---------- Date---------- <br /> SAN <br /> ate----------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street Lodi, California Manteca. California Tracy, California <br /> Stockton, California <br /> ES-9-2M 8-51 Revised W-2100 <br />