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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) Date Issued <br /> _--//--�/S3 <br /> T�plicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> 's application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.____ __?L__ <br /> Owner's Name --------*-------- - -------------------------- <br /> ---------------- <br /> ------------------------- ---- one....Z- <br /> ----------x--------(&j <br /> ­------------- ---41�:- -_------ p---------------- <br /> Contractor's Name <br /> --------------------------------------------------------------- Phone_-.- <br /> Installation will serve: Residence� Apartment House E] Commercial [-] Trailer Court E] Motel E] Other <br /> ❑ <br /> Number of living units: ___-f_ Number Of bedrooms 3_ Number of baths _�Lot size <br /> Water Supply: Public system E] Community system Ej Private 2f, Depth to Water Table =7;�_ ff. ------------I--------- <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel Ej Sandy Loam E] Clay._Loam 0 Clay 0 Adobea Hardpan E] <br /> of, Or <br /> Previous Application Made: Yes El No New Construction: Yes 0 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 fr9m founclaflon--.457 <br /> No. of comparfmenfs--.----:!!�17-----10-I----Size_j) ,), , -e? --------Capacity_- ------4 <br /> ----Liquid depth---A-,f ---- <br /> D;sposai Field. Distance from nearest well__._--_____ 46 <br /> Distance from founclafionls_r------Distance to nearest lot line___' <br /> ---Length of each line------ #e------ Width of trench---16W <br /> Number of lines___.____-_I <br /> Type of filter material___ ----Depth of filter maferial -----Zf- I.........Total length-j-.0-0............................ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____-______..__ <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter_------- <br /> ---- --------Depth----- -------------------- - <br /> esspool: 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-------------------------- ---------- <br /> F-1 Distance to nearest lot line <br /> ------------------------------------------------I--------------------------I------- <br /> Remodeling and/or repairing (describel:--------------- /_ /-------- <br /> -- <br /> f <br /> ---------------------------------------- ')1c ---- - --- - --------- --------------------- ------/_& 0 ----------- <br /> - ------ ------- --- <br /> 9--- ----------------------------------------- <br /> --------------------------------------------------------------------------------------------------------- -- ------------------ <br /> --------------- -----------------------------------------I----------------------­----------- <br /> --------------------------------I------------------------------------- -------------------I-------------- -------------------------------I--------------------- --------- <br /> he re ared this application and that the work will be done in accordance with San Joaquin Count I <br /> y <br /> V <br /> ordinances, St w I s, and rules an regulations of the San Joaquin Local Health District. <br /> - <br /> ---------------------------------------------------------------- _�or Contractor) <br /> (Signed)----------- -------- --- <br /> By:--------------------------------------------- <br /> ------------- - ---------- <br /> (Plot plan, showing size of lot, location of sysfe n relation f'o'-w-ell,---buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED.BY <br /> REVIEWEDBY ------------------------- --------------------------------------------------------- DATE_e!=!7�------------------------------------------------ <br /> ------------------ DATE -P <br /> BUILDING PERMIT ISSUED------------- ----------------------------------------------DATE------------- -- - -- -----------------------------*------------ <br /> ------ ------------------- ------------------------------------------------------------ ------------------------------------------- <br /> Alterations and/or recommendations <br /> -------------------------------------------------- <br /> --------------------------------------------------------------I---------------------------------------------------------------------------- -------------------------------- ------------------------------------------- <br /> ----------------------------------------------------------------------------- ---------------------------------------------------------------------- -------------------------------------------------------------------------- <br /> ­------------------------------------------------------------------------------------_------------------------ ----------- -------------------------------------------------------------------------- <br /> --------------- ---------I------------------------ <br /> - ------ ---j_-- - <br /> ---- ------------ - ------------------------------------------------------------------ <br /> ----------------------------------------------------------------- <br /> FINAL INSPECTION BY:. _)1 /_--- --------- 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 10-52 Revised W-2100 <br />