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7 90 1 :1 1 <br /> Permit No.,----f---�-6------- <br /> APPLICATION FOR SANITATION PERMIT <br /> IN (Complete in Duplicate) Date issued <br /> 'b <br /> Alication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This . <br /> ppo, <br /> Napplication is made in compliance with County Ordinance 54 __CAP --------- ------------------------------------------------------------- <br /> ... ..... ... <br /> ----------/----5-1-------------------- --- ------- ----------------- <br /> JOB ADDRESS AND LOCATL(�,N---- ---------------- Phone------------------------------------ <br /> �f- ----------q-----------=---- <br /> ­14�-------- -- <br /> Owner's Name------------------- r- ------- - ------------------------------------------------------------------- <br /> Address---------------------------------------•------------------------------------------- ------------ Phone----------------------------------- <br /> ... - --------------------------------------------------------------- <br /> Contractor's Name__________________"-_--- ------- C Other <br /> Installation will serve. Residence �partm�entHouse [I Commercial 0 Trailer Court [j Motel 0 <br /> e ------- or-1 x---- ----------------- <br /> Number of baths -------- Lot siz -4d----/--- <br /> Number of living units: Number of bedrooms ---/-- fe 0 Depth to Water Table -------- ft. <br /> Water Supply: Public system D Community system 0 Private ClLoam El Clay [] Adobe Eq.A�ardpan D <br /> Character of soil to a depth of 3 feet.- Sand 0 Gravel El Sandy Loam 0 ay <br /> Previous Application Made: Yes 0 No 01-l' New Construction: Yes No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -.Material-------------------------------------------------- <br /> p� Tank: Distance from nearest well-----------------Distance from foundation_____-____-__-- Capacity----------------------- <br /> Se f' <br /> �1411 a 1-1 <br /> ..,t Size--------------------------------Liquid depth-------------------------- <br /> WV�No. of compartments--------------- - ------ <br /> Z. e from foundation_- ----------Distance to nearest lot line <br /> IDI 11.400?4 k-Distance sf a n c (0 trench_______-)�- I f <br /> Disposal Field: Distance from nearest well'- - ........ of tiren --- ----------------- <br /> ------------------Length of each line--- gfh------------ -1----------------- <br /> Number of lines_______________ - Total len <br /> Type of -filter material <br /> . r'aj Depth of filter material----_! <br /> ---.Distance to nearest lot line_________________ <br /> Seepage Pit: Distance <br /> ine----------------- <br /> Distance to nearest well----------------------Distance from foundation-__-__.____------ <br /> Pit: Number of pits----------------------Lining material---------------------- Size: Diameter----------------- <br /> Depth--_------------------------------ 041 <br /> 0 Distance from foundation-------------------Lining material-------------------------------------- <br /> Cesspool: Distance from nearest well -----Liquid Capacity----------------------------gals. <br /> Size: Diameter-------------------------------------Depth_---------------------------------------------- <br /> DrDistance-from-ne'aresf building-�­------------------------------------ <br /> Privy.: Distance from nearest well---------- ------------------------------------------------------------------------- <br /> F-1 Distance to nearest lot iine-------------------------------------------------------------------- --- <br /> Remodeling and/or repairing (describe)*:----------------------------- <br /> -------- -------------I-----------------I--------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------I----------------------------------------------------------------------------------I------------------- ------- <br /> ----------------------------- ----------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------I-------- -------- ----------------------------------------------- --------------I---------------------------------------------------------------------------- <br /> ---------------------------------------------------------- ---------------------- that the work will be done in accordance with San Joaquin County <br /> I hereby certify that I have prepared this application and uin Local Health District. <br /> ordinances, State laws, and rules and regulations of the San Joaq <br /> l ___(Owner and/or Contractor) <br /> (Signed)---7<-�!--- ------/--- ------------------------------------------------------------------ <br /> ................. --------- <br /> ------ -------------------(Title)---------------------------------------------------------------- <br /> -------- ------------ <br /> BY=-----------------------------------------------------------V-----------------------------wells buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot, location of system in relation to <br /> FOR DEPARTMENT USE ONLY <br /> ATE----------- <br /> APPLICATION ACCEPTED BY________________ - DATE------------------------------------------------------------ <br /> -- --------- ------------------------------------------- <br /> REVIEWED BY------------------------ ---------- <br /> - <br /> ------------ DATE------------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- --------------------------------­--------------------------------- <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------ ----------------------- -------------------------------------------- <br /> ----------------------------------- <br /> ------------------------------ -------------------- ------------- ----------------------------------------------------- --------------------------------------------- <br /> ----------------------------I------------------------------------------------------- ----------------------------------------------------------------------------------- ----- <br /> ---------- ------------------------------------------------------------------------------------------------------------------ ---------------------- ---------------------------------------------------------- <br /> --------- -I----------------------------------------------------------------------------------------------------------- <br /> -- ---------------------- <br /> ---------------------------------------------------------------------------- ( 11-V <br /> --------------------------------------------- <br /> FINAL INSPECTION BY------------------- ------------- --------------------- Date-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 Scamore Street 814 North "C" Street <br /> 130 South American Street 300 West Oak Street y <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M B-51 Ravrsed W-2100 <br />