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VI/ ft. <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> %9 (Complete in Duplicate) I- <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 j <br /> ---�5�t . ............... <br /> JOB ADDRESS AND LOCATION____.j,-- ---- - ----- ------- <br /> 4;Z -10 -----__J/- <br /> Owner's Name---------------------- <br /> Address ---------------- - C � <br /> Phone <br /> - �7*- ------- - -- <br /> rm­��X7------ ------------------------------------------------- ---------------------------------------------------------------------- <br /> ------------------------------------------------ ------ <br /> Contractor's Name----------------------------- - ----------------------------------I------------------------------------ Pho <br /> Installation will serve: Residence [X Apartment House El Cc.mmercial [I Trailer-Court C1 Motel E] —Other El <br /> Number of living units: ---/--- Number of bedrooms -.Ir-- Number of baths -*'4-e--' Lot size ----------/0-d_______..... _. ------- <br /> Water Supply: Public system � Community system El Private [] Depth to Wafer Table �Q ft. <br /> Character of soil to a depth of 3 feet:, Sand 0 Gravel El Sandy Loam El Clay Loam F1 Clay 0 Adobe-m_ Hardpan ON�Qi <br /> Previous Application Made: Yes [I NoJR New Construction: Yes 0 No El 6��C�_ ha- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> pfic Tank: Distance from nearest well----------------- Distance from foundation---------------------Material------------------------------------------------- <br /> No. of compartments-------------------------Size--•--- ------------------ Liquid depth--------------------------Capacity--------------------- <br /> -,st lot line---A9-_2 <br /> LN-sposa.1 Field- Distance from nearest weII14§1�__Disfance from to near( <br /> Length of each line t -o'_ffr,nch.,_ <br /> Number oi lines---------/----- ------- I ------ �jo <br /> f ........1_,/9_z`__TofaI length------ <br /> Type of filter material---t X- ------ -Depth o filter material .1 7 <br /> Seepage Pit: Distance �o nearest Well­_N_17�----Distance from foundation---/S__-____.Disfance to nearest lot line--L-o___'__ <br /> Lg� Number of pits____)________________Lining material bi,__ Dept <br /> _C4_1�1i4_.-Size: me -------------- <br /> Cesspool: .Distance from nearest well-----------------Distance from foundation_---------------- Lining material------_------------------­­------ <br /> El Size: Diameter-------------------------------------Dept h---------------------------:-----------------------Liquid Capacity------- --------------------gals. <br /> Privy:❑ Distance from nearest well----------------------------------- ______-------Distance from nearest building_.___________---_.___-________._..___.._ <br /> tonearest lot line--------------------------- -- ----------------------------------------------------z­__�---------------------------------------------;----------- <br /> Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------- --------------------------------------------------------------- <br /> -----------------I-----------------------------------------------------------11------------------------------------------------I---------------------------------------------------------------------------------------------- <br /> ------- --------------------------------------------------------------------------------------I----------------------------------------------------------------------------------------------------------------- <br /> -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- <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, ang-tuies and re ula�ti-s of the San Joaquin Local Health District. <br /> --------------------------------------------------(Owner w-Contractor) <br /> (Signed)-------------------------------tivt-� -- - ------------ <br /> By:-------------------------- - ------ ------------ ---- ---- -- -- ---- --------1,/4----- <br /> ---------------- <br /> (Title) <br /> (Plot plan, showing size of lot, location of system in relbti'd"n to wells, buildings, etc., can be placed on reverse side). <br /> FOk"DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------------------------------------------------------------------------------- DATE---- <br /> -------------------------------------------------- <br /> ____--_,!�_-�---------_1------------------------------------ <br /> REVIEWED BY-------------------------- ------- -- <br /> --- ----- -------------------------------------------------------------------- I <br /> DATE <br /> BUILDING PERMIT ISSUED----------------------------- ------------------------ ------------ DATE--------- <br /> Alterations and/or recommendations: ----------------------------- ------------ <br /> ------------------------------------ - <br /> ----------------------------- ----------------------------------------------- ----------------------------- --------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------- -------------------------------------I---------------------1--------------------------------------------------- <br /> ------------------ -------------------------- --------- -------------------------------------- ------------------------------------•------•----------------------------------------- ----------------------------------------------------- <br /> -------------- -------------------------- <br /> ------------I------------------!------------------------------ _____1---------------- ------ <br /> - -------------------------------------------------------- . I <br /> ------------ ---------- ----------------------- <br /> ----------------- ------------------------------------------------------- -----------I------- ----------------------:-------------- ----------------­­--------------- - <br /> ,4D8te..7------- --------------------------------------- <br /> I <br /> FINAL INSPECTION BY: �f----V -1-Pd0-w-------------------- <br /> 1 r <br /> SAN JOAQUIN LOCAL-HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak S+raef 132 Sycamore Street 814 North "C" Sfraef <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ;5-9-2M 10-52 Revised W-2100 If <br />