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. 1 - � r <br /> APPLICATION FOR SANITATION PERMIT ::Permit-No. -- .-9. -- <br /> M � • <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applicaa•ion 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 <br /> - }, p.�► � <br /> .r <br /> f <br /> LOCAT <br /> ---,--J-- <br /> ----. <br /> Phone------------------------- <br /> Owner's Name -- ---- <br /> Address ----------------- - -- <br /> If <br /> ' 6� A <br /> Contractor's Name------ =- At ----j----------------------------------------- Phone � - <br /> Installation will serve: Residence Apartmenf ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: /----- umber of bedrooms .----_-- Number of baths - <br /> ------ Lot size --- ----r',- - �-�`�--•--------------------- <br /> Water Supply: Public system Community system ❑ 'Private ❑ Depth to Water Table_,?Q ft. <br /> Character of soil'toa depth of 3 feet: Sand ❑ Gravel E] fSandy Loam E] Clay Loam E] Clay ❑ Adob Hardpan [j�{ 1 <br /> Previous Application Made: Yes ❑jNo� NewConstructioYe jNo E]TYPE OF INSTALLATION AND SPIFICATIONS: <br /> (No sepfic tank'or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic Tank: Distance,from net-rest we4----- --1------__Distance from foundation_--_-____------.Material------------------------------------------------- <br /> �.. � Noof compartments Size Liquid depth Capacity ` <br /> Disposal Field Distance.fram nerest well---- - ---------Distance from foundation--------------------Distance to nearest lot line_-_----__-----__- <br /> fr- <br /> � � Numb of lines------------------=- 1-------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter ma ferial-----_---1---__-4-____Depth of filter material-_�-------------------Total length----_---._----------.---__--___-__--__--- , <br /> See a e Pit: Distance to nearett we -- -- -- _.--Distance f nl fc dation-_-I-- Distance to nearest lot <br /> 7 p g Number of pits---- -------------- Lining material <br /> �( __Size: Diameter Depth-.-c ... <br /> &" 06 <br /> Cesspool: Distance from nearest well.- ------Distance from foundation____------%------ Lining material-------------------_-----_--__----- <br /> ❑_ ..�... Size: Diameter--- -ww f�---------- -- .---------Depth---------------------------------- -----------------Liquid Capacity---------------------------gals.' <br /> E <br /> Priv Distance from rearest wel____*-----------------------------------------.-Distance from nearest buildingf <br /> ❑ Distance to nearestlot line------ -----------------•----------------------------------------------- - ` <br /> � L A <br /> Remodeling and/or repairing (describe)-------------- _____ t_-__.-----__-__- <br /> •--•- <br /> ------------------•_-_--------•---------------------- ----------------------------------- -• <br /> -------•--••--------------------•---------•-• ----------------•-------------------•-••-------•----------------------­­-------------------------------------------------------------------------------- <br /> -------- ----------------------------------------------=----- --------- -------------------------------------- --------------------------------------------------------------------------t--------} <br /> ----f-------- -------------------�--------"---`------X--------------------------------------------------------I-------------1-•----------------------- <br /> I hereby certify that I have prepared this application and 'that the ork will be done in accordance with San .Joaquin County* I <br /> ordinances,,State and r s a d r,`egul i ns f the San J8aquin Locel:tHealth District. <br /> (Signed)---------.. ' <br /> :---- <br /> -..�- ---`--- --------------------------------- ---=------------ (Owner a r C nt actor) <br /> e - 'buildings, etc., can be pl on <br /> $ ' - I , <br /> (Plot-plan, showing ss of lot, location of system in relation to wells, reverse side). <br /> FOR DEPARTMENT USE ONLY �. <br /> 4 <br /> APPLICATIONACCEPTED BY- -- ---- --------------------------------------------------------------------------------- DATE -------------------------------------------------- <br /> REVIEWED BY----------�-`------ ----- DATE ��- <br /> --- ----------- -- -------------•---------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------I---------------------------------------------------------- DATE---------¢h •------------------------------------- <br /> ---- -------�--------------------- ----------------------------•------------•-----------------------• <br /> Al+era+ions and/or recommendations:-- --.-_-- "" __-----.- <br /> ------------------------- -------------------------------= ---------------------------- •---•--------------- <br /> -•--- ---- }A <br /> ------------ -•---------------------„,----•- ----- <br /> ---------- ------------------------------------------------------- --------------------------------- <br /> ---- ---------------------- <br /> --------------------------------------------------------------=--•-•--------------------------------- <br /> 4111 <br /> FINAL INSPECTION <br /> BY: _ ------------------------ Date �` / .. -.;1. ------- <br /> 1 - <br /> SAN JOAQUIN LOCAL;HEALTH DISTRICT <br /> 130 South American Street 300 West Oak�Street 132 Sycamore Street $la North "C” Street <br /> Stockton, California, Lodi; California Manteca, California Tracy,,California <br /> ES-9-2M Revised W-2100 <br />