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C/ <br /> APPLICATION FOR SANITATION PERMIT Permit - <br /> No.A__J -t------ <br /> (Complete in Duplicate) Date Issued �0___7_ __S,2-,l <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construe and I st fk ork here' desc 16ed. <br /> This application is made in compliance with Count Ordinance No. <br /> JOB ADDRESS AND LOCATION- ------ -- <br /> ------ -------e 01--------------- -- -----­­--------------- <br /> Owner's Name----------- .....0--------- ---------- -- -- ----- - ----------- hon <br /> Address----------------------- ---- -- ------------ -re------------------------------------------------------- <br /> Contractor's Name---------- --------- <br /> 9�_ - -------------------------------------------------------------------------------------------------------- Pbone- <br /> Installation will serve: Residenceg Apartment House E] Commercial F] Trailer Court Ej Motel Other El <br /> Number of living units: __/--- Number of bedrooms Number of baths --- Lot size � /° —----------- ------------ <br /> -E] Commu6ify system 42 <br /> Wafer Supply: Public-system Privafee5( Depth to Wafer Table _1�4 ft fes; <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loa Clay Loam 0 Clay E] A e E] Hardpan <br /> Previous Application Made: Yes E] No-Er New Construction: YeA No E] <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 ----Distance from founclation__,Z�---- Mafer,,_�_ <br /> Size___ Liquid depfh---.,?P-- apacity- <br /> H_a, <br /> "'o Hardpan <br /> ------ <br /> -- ------ --- <br /> t <br /> a6 y - ----------No. of compartments-------0--- -------- 'p <br /> Distance to nearest lo line___ ______ <br /> Number <br /> Field: Distance from nearest well- --------Distance from fpundail:�n/_ ------ _h <br /> ------ -------------- <br /> Number of lines--------- --------------- ------Length of each line------ ------------width of trench----.Z---------- -- ------- <br /> Type of filter material__ 4-----Depth of filter material___ ---T--------------Total length_____15; --------------------------- <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation___________________Distance to nearest lot line----------------- <br /> 0 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------------------%?b <br /> r_1 Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals. <br /> 'Privy: Distance from nearest well-------------------------- ------------------ __Distance F(5m_nearesf­bdiQIing__'_---------- -------------------- <br /> F1 Distance to nearest lot line ----- --------- -------- ----------- <br /> /----- -------- <br /> r R del' g a�d,4/or e,�Irinq.(describe):------- <br /> /I/V -------7- <br /> M Zo-------- . .................. ------------------------------------------------------- <br /> C <br /> 7_7 ---------------------------------------------------------------7- <br /> - - ---------------------------1-__--------I--------------- ­­------------------------------------------------------------------------------------------------------------------------------------------- <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, Statek and rules and regulations of the San Joaquin Local Health District. <br /> Z /- -------- -- ---------`--------------------------------------------------(Owner and or tractor <br /> (Signed)------------ <br /> ----------------------(Title)--- <br /> By:-----------------------------------------Z- --- ------- <br /> 2, <br /> (Plot plan, showing size of lot, Iodation of sys/+em in'relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 13Y___ __-- ----------------------------------------------------------------------------- DATE <br /> REVIEWEDBY------------------------ -------—------------------------------------ DATE__ �,•----------------------------------------------- <br /> BUILDING PERMIT ISSUED------ ----------------------------------------------------------- ---------------------------- DATE-- ----- ------- ------------------------------- <br /> Alterations and/or recommendations:--- --- ---------------------- --- ---- <br /> - _�)------------------------------- <br /> - -------- -------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------I--------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------- <br /> ---I---------------------------- <br /> --------------------------------- -----------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------- ---I-------------------------------------- --------------------------- --------------- ---------------------------------------------------------------- <br /> FINAL INSPECTION 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 8-51 Revised W-2100 <br />