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APPLICATION FOR SANITATION PERMIT Permit No. al <br /> (Complete in Duplicate) Issued C:> <br /> Date ----- <br /> Application is hereby made to the San Joaquin Local Health District for a per gnif to cons r ct�fall t oPerein described. <br /> This application is made in compliance with County OrdinAnce No. 549. <br /> JOB ADDRESS AN LOCATION _-Z&---- ----10%V------- -------- ------------------------------- <br /> -------- - ------------------ ------------------- --- e----------------------------------- <br /> -- -- ------------- <br /> Owner's Name./? ---- ----I ---_---------7P Phone----------------- <br /> ------------ ------------------------ <br /> ins r <br /> Address---------ffli---------- --- — --- -----------4--------------------- --- -------- Phone-------:--------------------------- <br /> -------------- ____ <br /> Contractor's Name---------��4--------------------------------------------- ----- <br /> Installation will serve: Residence Apartment House E] Commercial [] Trailer Court [] Motel El Other El <br /> Number of living units: A----- umber of bedrooms _____L Number of baths Lot size <br /> Water Supply: Public system [] Community system 0 Private X Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam 0 Clay Loam El Clay El Adobe 0 Hardpan 0 <br /> Previous Application Made: Yes)A, No E] New Construction: Yes A No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well Distance from foup�.ation----/0-----------Mater, I--------------------------------------- ---------- <br /> PNo. of cc,rrparfmenfs_.__-7,--_._-.------ ----Size---L1_X__ 3-W-Liquid depth-------------I-__---------Capacity----1._Z <br /> Disposal Field: Distance from nearest well....I-S -Distance from foundation------1_0----.-.Distance to nearest lot ]in,---..5--------- <br /> Number of lines--------I------ Length of each line------ -----------Width of trench-----7—- ----------------------- <br /> Type os filter material-S- <br /> Depth of filter material____._________ _____Total length_._________._.________- _-___________.._. <br /> ' <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation________-_.-____.-. Distance to nearest lot line----------------- <br /> 171 Number of pits----------------------Lining material-----------------.-----Size: Diameter---------_------------.Depth-_-------------- ------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material___________----____.______--_._.___ <br /> El Size: Diameter------:------------ ------_--------•--.De pth------------------------------------------- Liquid Capacity_------------ <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------.----------------------------------. {3 <br /> ❑ <br /> uilding------------------------------------------ <br /> ElDistance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- -;::7 <br /> �_ g�f and/or r 7airing jdescrlib!�: ..... <br /> lAotik oA: ----Z;i C <br /> Rempdel er . .... <br /> )-4 <br /> ------- ----------- -------- <br /> -------------- <br /> ------------ -------- ----------------- -------------------------------------------------------------------------------------------------------------------- <br /> Q ---- ---- I0 <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 !ul -st—a—n �guiafions of the San Joaquin Local Health District. <br /> (Signed)--11�- -- --------------- - ------------ ------------- ------------------------------- ----(Owner and/or Contractor) <br /> --- <br /> B <br /> ------------------------------------- <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE------------ <br /> APPLICATIONACCEPTED BY---------------------------------------- ,r'-- - ------------------------- ----------------------- <br /> �;,Ov......................­­----- DATE <br /> ------1-C -1---------------------------------- <br /> REVIEWED BY-------------- I <br /> SUED----_---------------------- ------------------------------------------• DATE------------------------------------------------------ <br /> ------------- <br /> BUILDING PERMIT IS <br /> Alterations and/or recornmendations:_--------- --------j _ -----------------------------------------------•----------- --------------------••-•--------------------------------------------- <br /> --------------------------------------------­ --g ----- - -------- --------------------- <br /> ---------------------- ----------- --------- ------- -- --- ------------------ <br /> ..'a ------------------ <br /> -------------------------------- ------------------------------- ------------------------------------- <br /> --------------------------- <br /> --------------------------------------------- ---------------- ----------- ------------------------- -- <br /> - <br /> -------------------------------- -- ---- -- --------------------------------- -5------------------------------------ <br /> r) Ry. ---------------------------------- --------------------------------------------- <br /> FINAL INSPECTION BY:------- ---------------------------- ------------------------- 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 10-52 Revised W-2100 .11 <br />