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r x <br /> ! �( APPLICATION FOR SANITATION PERMIT <br /> p Permit No. <br /> {C <br /> am late in Duplicate) �-- ----�-------- <br /> I � � <br /> Date Issueda___-__-�/S ' <br /> Applicafion is hereby made to +he San Joaquin Local Health !);strict for a permit to co <br /> This applicatioI is 1made. in,compliance with ounty rd) an No r�qg <br /> A 'll _ Al F S7— +�ct,and i st ll the herein described. <br /> JOB ADDRESS AND LOC TION_ _ / y� 2 � <br /> Owner s ----- -- <br /> Address---„�.� ------�"-- - -- . <br /> :. .�-....i....... ---------------------- P <br /> 0 .3 <br /> .5y� <br /> Contractor's Name------------•-"_"--- -• t_ "".----•------ <br /> Installation will% serve: : Residence �� <br /> ---- <br /> Pho e," <br /> Apartm nt Hous e 4 x - �-=��5-�� v <br /> F Number of living units: ❑; Commercial <br /> E F� g ❑ Trailer Court ❑ Motel Other ❑ <br /> Water Supply: <br /> -” Number of baths ._l"__ Lot size <br /> Public#"system Number <br /> bedroom �---- ­"_Q-""---""-" <br /> •Cloaracter of soil to a depth of 3 feet: Sandy system Prwate ❑ Depth to Water Tabfe�_ j <br /> x "� U ft. <br /> Previous Application Made: Yes ❑ Gravel ❑ `$andy Loam <br /> ❑ No ❑� Clay Loam ❑ Clay ❑ 4d0bq-t�'TYPE'OF INSTALLATION AND SPECIFICATIONS;Now Construction: yeS i NoHardpan ❑ <br /> (Na sep}ic tank r cesspool permitted if public sewer is available within 200 feet. <br /> Septic Tank: Distance from nearest <br /> "r- ---_Distance from foundation___,/ Materr l__ <br /> No. of compartments ' <br /> -- ------ --- Size"_" f_--- ----- � . - <br /> Disposal Field: � <br /> yx ---Liquid depth -yr <br /> Distance from nearest well---__----.---_-Distance from foundation_ "-"- 3-, Capacity.__ Op j <br /> Number of lines---------------­------------------Length of each line----------------- Wsdfhcofttrenc{�f est lot line-------------- <br /> ------------ <br /> ---" " � <br /> Type of filter material"__.__-"-_.__"_" " <br /> Seepage Pit: Distance to nearest ell_ %cam """Y Depth of falter material"_ <br /> - ---------Total length-' � <br /> "� Distance from fo dation__ " __ --------------------------------------- <br /> Number <br /> of pits-------!-------------Lining -��--••--.Distance to nearest lot line" �.______� <br /> Cess ool: material__ "� Size: Diameter_ <br /> pDistance from nearest well" "_-_-----_ Distance from found <br /> , » ------ <br /> e: Diameter-"- -" anon..-. Lining material----------------- <br /> ------------------- <br /> Depth----------------------------------------------------------- <br /> Privy: 4 rLi uid Capacity.- ---- --ga <br /> Distance rom nearest well--------------"__--" Q �# <br /> ❑ Distance to nearest lot line"_f''!.._-""�- _ <br /> -----------Distance from nearest buiidin <br /> ------------ <br /> Remodeling and/or repairing (describe)--------------- <br /> ------------------- <br /> --------------------- <br /> -------------------------- ---•--------•-----'-------------------------- "" .__ --------------------------------- ------------ "--------- <br /> y <br /> -""._•____"-""_____""."""..-----`----••----•-------•-------- <br /> hereby certify that I have prepared• this application and that then <br /> done-'in--accord- <br /> n accordance with San Joaui <br /> ordinances, State laws.'and rules work will b <br /> es and regulations of the San Joaquin L wo Health District, i q Y <br /> - ---- -- <br /> n C-ount- - <br /> (Signed)---------- ------ ; •--••- <br /> By:. - <br /> (Plot plan, showing size.o of, location of system in relation to wells, buildings, etc., can be <br /> _ act <br /> caner and/or Contractor) <br /> ~--_____ r <br /> e placed on reverse sidle), <br /> FOR D PARTMENT USE ONLY <br /> ° 1 r <br /> APPLICATION ACCEPTED BY_ _--__ <br /> REVIEWEDBY------------- ---------------------- ---------------•----------i------------- <br /> DATE--------- --------� - r <br /> ------------------------------------------------------------------ -- ---- <br /> UILDING PERMIT ISSUED----•---------------------"--"-- -- `- <br /> BATE --- - <br /> Alterations and/or recommendations:---- --------- " ------------- <br /> ------ <br /> ------•----------------------- DATE-----'-.- .' <br /> --- <br /> -------------- <br /> --------------------------- <br /> r <br /> ----------- <br /> ------------- <br /> -' ----------------- <br /> --- --------------------------- <br /> ,r ------------ - ---- <br /> FINAL INSPECTION BY:_____________ <br /> .4n 1,e4,- <br /> bate----- ------- �-----� .2 .`..�5��-�-•�-,..�..�_ <br /> -----------f---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> 300 West Oak Street <br /> NSt. kion,;Celiforni6 a #' ,, 132 Sycamore Street 814 1�lorth "C" Street <br /> Lodi, California Manteca, California <br /> " �• Tracy, California ` <br /> ES-9-2M 10-52 Revised W-21010 ti <br />