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APPLICATION FOR SANITATION PERMIT i'i��P_ermit No. _--l-- -9L---.. <br /> (Complete in Duplicate) a <br /> Date 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. I <br /> 60�, <br /> T�.ON �JOB ADDRESS AND LOC -- K-8 ' <br /> . <br /> Owner's Name---------- 1 <br /> �] _=---=------- Phone- <br /> Address--------•-••-••--. -•y----- �-----1 -----r� ------ - - ------------------------ --- l -... <br /> Contractor's Name - - ----------------------- -------- Phone -- <br /> hone - <br /> Installation will serve:, Residence artment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ <br /> Number of living units: _- -.-- Number of bedrooms ---I--- Number of baths ---1__ Lot size -:= -_-_--------A1--_ ' �~ <br /> Water Supply: 'Pub1ic;system ❑"-Community system ❑ "Private Depth to Water Table ---------- <br /> Character <br /> -- -"Character of soil to a*depth'"of.3'feet: Sand ❑ GravelX Sandy Loam Clay Loam❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Ye� No ❑ r FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION SAND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Sep is ank. T-' Distance from nearest well__ _ ---Distance from foun ion____ .Q-_---.Mat rill--.-- . <br /> f ' `No of compartments__--- �_: ----Size- � - _- Liquid depth_----- '_ 11 Capacity... <br /> - -� -- <br /> Disposal Field: Distance from nearest wellDistance from foundation-.._./. '''_.Distance to nearest lot line_--- _. <br /> Number of fines--------I------- ----_ ____Length of each line-------- ... ;��--.Width of french----- -_ �----------------� <br /> Type of filter material- ��i� ---Depth of filter material---.---J-8___-___Total length---------40--0------------------------ <br /> Seepage <br /> -------------------- UV <br /> Seepage Pit: Distance to nearest well: ` `-----_----Distance from foundation________------------Distance to nearest lot line-------..____-. O <br /> ❑ Number of pits------ -------- ------Lining material-----------------------Size: Diameter----•--------------------Depth_t------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-------------------------------------- 1 <br /> ❑ r Size: Diameter------ -------------- °.Dept h:---- = <br /> ---- -`--------=---=------- ------Liquid Capacity-� `----- .-------------gals. 1 <br /> ----- -------------- Distance fram nearest building-----.-.-______------------------------------------------- <br /> Privy: Distance from nearest'well---------- <br /> 4 <br /> ❑, <br /> Distance to nearest-lot-line-__-°-:- - :-� -- - ,- - -w-- M" <br /> rt .. <br /> Remodeling and/or repairing (describe):------1.- _----___ - '"_. 4--_-a_--- _ -;; __-__, _ _ _ ' <br /> --- --------------------------------------- ----------------------------------------------------------------------------- --- -------------------------- --------------- <br /> ------------------ ;---------------------------------------------- ----------...•--------------------------------------------- ------•-----------------------------------•----------------------------- ------------ <br /> ----------------------:-------------------------------------------- <br /> ------------------------------------------------------------------•--------'------------------ --------------------------------- --------------------------•--•---------------------------------------------------•------------ <br /> I hereby certify that l have prepared this application and'',that the work will be done in accordance with San Joaquin County <br /> ordinanite$rState ws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed}i- -"- - ------- �._-- -_ _ -- - - - ------------------------------------------------------(Owner and/or Contractor) <br /> e I <br /> (Plot plan, showing size of lot, location of system in relation-to wells, buildings, etc., can be placed on reverse side). 1 <br /> FOR'DEPARTMENT USE ONLY <br /> ----------- --------- ------------ ------ -�------- ---------------- -- <br /> APPLICATION ACCEPTED BY----------------------- -- ------- - -L-- . - DATE-------DATE---- <br /> BUILDING PERMIT ISSUED---------------- -•--- g----------------------------. g..... <br /> -- -------------------------- g->t-��_,-.-•------ ------------------------------- <br /> REVIEWED BY--------------------------- ---- ----- --- --- <br /> -------------- --r' _E -- <br /> Alterations and/or.recommendations:.------------------- ---- ---- -----------••= I <br /> -------------------------------•--------------------------------•------------------- __ -----------------------•------------------•---------------------------------------------•------------------------------------ <br /> 1 <br /> ------- ---------------------------•-------------------------•-----------------------------------•---•-•--------------------------------•----------------------------------•..-•-----------------•-•-------•--------------= <br /> •------•--------------•------------------------------------------------------ ----------------- --------------­ -- ------------------------------------------------------------------- --------------------------------- <br /> R <br /> I - _ t <br /> n- ---------------------------------------•-------•-- --------------------------------------------------------- <br /> N <br /> --------------------------------------------- <br /> ----`--_-- <br /> FINAL INSPECTION Date ---------------- • <br /> ------- <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 , Revises 1.57 F.P.CO. <br />