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r •�. <br /> ZJ <br /> '� APPLICATION FOR SANITATION ` <br /> � '` .� N FERMI Permit � h <br /> (Complete in Duplicate) <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. _y <br /> This application is made in compliance with County Ordinance No. 549 k <br /> JOB ADDRESS ANDCATION._____, ---------- <br /> ------------ <br /> ------- -- - <br /> Owner's Name------- - ---- ---- F <br /> . - - -- ------ ----- ----------------------------------- <br /> : Phone, -l., ---------------- <br /> Address- <br /> .-•----------- --------------------------------------------•--------------------------------- -------------•----------------- --- <br /> Contractor's Name------------------- ----------------------------------------------------------------------------------- <br /> Phone-- <br /> Installation will serve: Residence Apartment House (] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ------- Number of bedrooms__ Number of baths _--L Lot size __ <br /> Water Supply: Public systemPZ' Community system 0 Private ❑ Depth to Water Table s-ft- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel.❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adob Hardpan ❑ <br /> Previous Application Made: Yes E] No New Construction: Yes El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--=------------_Distance from foundation_-__-----__-----___.Material------------___} __--_ i <br />' �y ------ ------------------- <br /> ,l ,1r No. of compartments--------------------------Size--------------- Liquid depth------------- Ca acit <br /> P Y <br /> Disposal Fief Distance from nearest well------------------Distance from foundation__-------_-_-_-----Distance to nearest lot line_-__-_-----__---- <br /> y1 Number of lines-----------------------------------Length of each line-----------------------------.Width of french_-$=----------------------_--- <br /> Type of filter material--------------------- -- epth of filter material-----------------------Total length---------------------------_-•-----_ <br /> 5eepa a Pit: Distance to nearest well- � i <br /> ___- istance fro anon- a_-__--__.pistance to nearest lot line___._ <br /> ---- <br /> Number of pits- ---- --------- ing material - -.Size: Diameter------ ----�- <br /> ,� -------.Depth---�_�---------- ------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------- <br /> Size: Diameter--------------------------------------Depth--------------------------------------- -----------Liquid Capacity ---gals. <br /> Privy: Distance from nearest well---------------------- .--_--Distance from nearest building ; <br /> ❑ Distance to nearest lot line----- - --------__ <br /> Remodeling and/or repairing (describe):------_-__- __ <br /> --------=----•--------------------------------------- <br /> ---------------------------------------------- <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, les a r lations of the San Joaquin Local Health District. <br /> (Signed)----------------------- ------ ----------= ------------------------------------------------------ (Owner and or C ntracfor) <br /> By:------------------------------------- --- F- Title <br /> ( ) - ----- <br /> o, ' • <br /> (Plot plan, showing size of to , ation of system in relation to wells, buildings, efc., can be place on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED-BY.- <br /> DATE--.Z ----------------I BY ------ ----------------- DATE-----�'1- - s <br /> Alterations and/or recommenrafions ------------------------ -V <br /> BUILDING PERWT ISSUED-------------------------------- DATE----------- - <br /> ---------------------- <br /> -------------------- <br /> ----------------------------------------------------------------- ---- <br /> ----------------- ---- -------------------------- <br /> ---------- <br /> -----------------------------------------4-­-----------------I--------------- <br /> HNA <br /> -- <br /> HNAL INSPECTION 8Y: ___----__--____---___ -- <br /> �� = Date---- <br /> SAN JOAQUIN LOCAL. HEALTH DISTRICT <br /> !30 South American Street 300 West Oak Street 132 Sycamore Street 814 NorthC" <br /> " Street <br /> Stockton, California Lodi,.California Manteca, California Tracy, California <br /> �f <br /> ES-9-2M 8-51 Revised W-2100 <br />