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APPLICATION FOR SANITATION PERMIT Permit No. -27:�-?-•------- <br /> • <br /> (Complete in Duplicate) Date issued <br /> ct for a permit to construct and install the work herein descr;bed- <br /> Application is hereby made to the San Joaquin Local Health Disfri <br /> This application is made in compliancg with County Ordinance No. 549. 0 <br /> I' ----AW------- ------------------------------------------- <br /> JOB ADDRESS AND LOCATION-:: ---------------------------------------- Phone------------------------------------- t <br /> lo'd . ............ ---------------------- <br /> Owner's Name___. <br /> ------------------------------------------- -------------- -----------------I------ <br /> --- --- ---------- <br /> Address----•----- __ Phone----- - <br /> Contractor's Name----- <br /> Residence C] Apartment House [I Commercial Trailer Court [:] Motel, ❑0. Other [3 <br /> Installation will serve: of bedrooms -------- Number of baths -------- Lot size ------ <br /> Number of living units: -------- Number tem [] Private 0 Depth to Wafer Table--V1-S <br /> El 7ff. <br /> Water Supply: Public system Community SYS Clay 0 Adobe 2K Hardpan [I'%%, <br /> Character of soil to a depth of 3 feet' Sand [I Gravel n Sandy Loam El Clay Loam El <br /> Previous Application Made: Yes El No'k. New Construction-. Yes [] Nox <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet <br /> Distance from nearest weIt-----------------Distance from foundation__--_____----------Materla�------------------------------------------------- <br /> Tank: Liquid depth--------------------------Capacity----------------------- <br /> Septic Size------------------------------- <br /> No. of compart;nenfs--- ---------------------- foundation line­i��--------- <br /> Distance to nearest lot <br /> ,--/-fis-po at Fiel�d! Distance from nearest well nce from -------------------- <br /> of each line----1-3-0..............width of trench-----2-44 <br /> Number of lines-----------I -__-_Length 10� length-----kop-A­!�------------- <br /> _t Total <br /> _X--- Depth of filter material------le--" 'line <br /> ild Type of filter material,/ _ _t _ e from foundation--------------------Distance to nearest tot ----------------- <br /> Seepage Pit-- Distance to nearest well----------------------Distanc ...................Size: Diameter-----------------------Depth fine---_--------_- <br /> of pits----------------------Lining material---- <br /> nce from foundation-------------------Lining material------------------------------9-a-S. <br /> Distance from nearest well-----------------Distan ------Liquid CapacitY­­--------------------- <br /> Its, <br /> Cesspool: A;7-- <br /> -------------Depth---------------------------------------------- <br /> Size: Diameter------------------------ -n --------------- -------- <br /> El j-Distance­froMr eares+�buildinig---- <br /> Privy: Distance from nearest-well-------- ---------------------------- ----------- <br /> - ❑ to nearest lot line---------------------------------------------------------------------------- <br /> El ----------- <br /> cribe)-------------------------------------------------------------- <br /> Remodeling and/or. repairing (des ---------- ------------------------------------------------------------------------------- ------------------- <br /> ---------------------I----------------------------------------------------------- ------------------ --------------------------------------------I----------------- ------------------------ <br /> ----------I------------------------------------- ------------------- <br /> ---------------------------------------------------------------------------- ------------------------I----------------- <br /> I------------------------------------------------------------------------------------------------ A San Joaquin County <br /> -----------r--------------------- application and that the work will be done in accordance w_ <br /> I hereby certify that I have prepared this a Joaquin Local Health District. <br /> of the San <br /> ordinances, State I ws, an!dpos 4nd regulations <br /> 'ymr-j?rd/or Contractor) <br /> ---------- ....... <br /> (Signed)-- <br /> -----------------(Title)-- ------------ <br /> II <br /> ----------------------------buildings, etc., can be placed on reverse side). <br /> (Plot plan. showingsite of lot, location of system in relation to wells, <br /> FOR DEPARTMENT USE ONLY <br /> - ---------------------------------- <br /> ------- ---------I------- <br /> APPLICATION ACCEPTED BY_ ---------- --------------------------------------------------------------------- <br /> D'AT'E-- ---------------- <br /> --- -------------------------------------------------------- DATE------------------------?/-------------------------------- <br /> REVIEWEDBY---------------------------- --------------------------------------- ---------------------- <br /> BUILDING. PERMIT ISSUED--------------------------- ----I---------------A----------- ------ ----------- -- <br /> a i - ---- - I ��I ------- <br /> Alferati s a /or F.0 vr� dations: ------ -- ......i ---ld-: -- --------------------------------- <br /> 1- ------- - - ---- ---------------------------------------------- <br /> -------------------------------- <br /> ----- <br /> -----I------------------------------ ------------------------------------------------- <br /> mp ,�ZaT ------- <br /> ----------- -It--------- % -------- --------------------------------------- <br /> ----------- --0-- ----------------------- --------------------------------------------------------------------------------------------------- ----------------------------- <br /> - -------------------------------------------------- ------- ---------- - --------------------- ----------------------------------------------------------------------------- <br /> Date---- -----3/1 ------------------------------------- <br /> FINAL INSPECTION BY----/-,?,01--------------------------------------- <br /> ------ <br /> JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street <br /> 132 Sycamore Street <br /> 130 South American Street 300 West Oak Street Tracy, California <br /> Manteca, California <br /> Stockton, California Lodi, California <br /> ES-9-2M 8-51 Revised W-2100 <br />