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APPLICATION FOR SANITATION PERMIT Permit No. .__L��. <br /> (Complete in Duplicate) A_�. _Data-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 compliance with County Ordinance No. 549. <br /> JOB `ADDRESS AND LOCA ONS - �J�_ -3�------------------------------ ---- - <br /> Owner's Name-------------=------- a [WJE!/--uf- ----------- Phone.------- <br /> Address - E �e� = 3�/ f <br /> t ---- -------- <br /> Contractor`s Name---------------------------- ------ -- ---------------------------------------- -•-----•-•----.-.. Phone-----•------_--------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ ___ Number of bedrooms __Number of aths Lot size ._ -vif__ <br /> ______________ <br /> Water Supply: Publics stem ❑ Community system ❑ Private Depth to Water Table �__ <br /> Y Y Y Y P <br /> Character of soil to a depth of 3 feet: Sand 2' Gravel ❑ Sandy Loam ❑ Clay Loam 1771 Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:- <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 fee+.) F <br /> Septic Tank: Distance from nearest well__ P________ "' nc from foundation_La__-Y+�"MeteriaL____ _______ _.. 0 <br /> No'. of compartments________Cr____--_Sime___ _ _ _.___Liquid depth_�----------------Capacity..._ _ � m <br /> t Disposal Field: Distance from- nearest we€1-_53.mance from foundation_ _� -___ .� .istance to nearest lot li e___ <br /> I Number of lines_______ ______ _Length of each line________ ._ Width of trench____�� ------------------- <br /> �jrV_- �j <br /> Type of filter material.__5__Z_--_ __--- ._ epth of filter ------Total length-------�J <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_________________ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth-------__._----------------------� <br /> Cesspool: Distance from nearest well______.________Distance from foundation--------------------Lining material----------------------------------------N <br /> ;` -- - * t — 77 7Li uid Capacity also <br /> Size: Diameter---------=-----------------------------Depth-- --- -------------- --- ------- -- G P Y - 9 0 <br /> Privy: Distance from nearest well-------------------------------------------------Distance fromnearest building----------------------_-------------_-_--. <br /> r <br /> [] Distance to nearest lot line---------------------- -------------------------------------------=---------------------------------=--------------------------------------- <br /> Remodeling and/or repairing (dascr;be)=---------------------- -------------------------------------------------------------------------•--------------------------------------------------....... k <br /> t <br /> -------------- , <br /> n <br /> - - ------------••------------------------------•----•---•--------------------------------------------------------••----------------------------•-------------------- --=-------- -- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.... { <br /> Si ned v,�y� -- -- --------------------------------------------------------------(Owner and/or Contractor) <br /> gY� ' -------------------------------------�----------- - ------ -�-�^-------•----•-------------- �Titie} <br /> (Piot plan, showing,size of lot, location of system in relation to wells, buildings, etc.,.can be,placed on_re_verse side). <br /> R PEPARTNT USE LY <br /> APPLICATION ACCEPTED BY. --------- DATE.... ------- -------------------- <br /> REVIEWEDBY--------------------------------------------- ----------------------------------=-------------------------------------------- DATE---- -------------------------------------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------• ------------------------------------- DATE------------------------------------------------------------- t <br /> Alterationsand/or recommendation#---------------------------------------------/----- --------------------------------------------------•-------•-----•----••-----------••--------------------- <br /> � 6 •:_. _.._..- ---------------------__----------------------------- ...... ----------­---------------------------•-------•----------------------------------- --------- <br /> -------------------------- ------------------- -- --------- - ------------------- -- ------ -- -------- .... ---------------------•------------------------------------------------ ----------------- <br /> 1 <br /> - --- ----------------------------- <br /> FINAL INSPECT = Date----=- 1---- 7 ---------------------- i <br /> SAN JOAQUIN LOCAL HEALTH 'DISTRICT ' <br /> 130 South American Street 300 West Oak Sfreet' 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca,-California Tracy, California <br /> 3 <br /> - F <br /> ES-9-2M , Revised 157 F.P.CO- <br />