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----- ----->e <br /> APPLICATION FOR `SANITATION PERMIT Permit No- �`�._7------(Complete in Duplicate) Date Issued 7�0 <br /> ---0 <br /> Application is hereby made to the San Joaquin Loc alfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance wi+h C nty:6pfinance Nc� 549. <br /> JOB ADDRESS AND LO TIO ---- --------- ------------- <br /> Owner's Name---- ------ ------- .... --- ----- ----------------- -- ------- Phone---- --- --- ----- <br /> --- --- ------- <br /> Address----------•- --- ----------- --- --- -- --------I---- --- ---- ----------------------------------------------------------------------- <br /> Contractor's Name-------------------- ---- ----------- ------------- ------------------------------------- ---- - ---------------------------- --------- Phone-----------------------'p ------- <br /> Installation will serve: Residence Ap fmenf House ❑ Commercial E] Trailer Court [] Motel 0 Other,[] 1 <br /> Z_ Num er of baths --- <br /> oms -4: Lot size ------ <br /> Number of living-units: .----- -- Number of bedrooms --- <br /> Water Supply. Public system El Community system 0 Private Depth to Water Tabl ._ ft. <br /> Character of soil to a depth of 3 feet: Sand [I _Gravel Sandy Loam [:I Clay Loam [] Clay El Adobe E] Hardpan <br /> ❑ <br /> Previous Application Made: Yes E] No New Construction: Yes No <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__67)-----Dista3n- e from foundaaf;, ______- .Material-___ ----------- <br /> R 1 P__j_,6---------M ' . . -if <br /> Liquid depth---------------- -_-Capacity-------- <br /> No. of compartments---------- Size.. <br /> Y, <br /> Disposal Field: Distance from nearest Aell___C_pv�'Disfance from foundation----e-12-0_ ---Distance to nearest ]of line_ _. <br /> pq Number of lines----------OV __,�Ingth of each 140-y. 10 40.. width of;tr�nch...... A <br /> --------- -- ---- ------- ------------ <br /> Ir- Type of filter maferial."�J. .... -----------I Aso <br /> ------- epfh of filter material__.____/_-F......Total length----------/-------(2.... <br /> from foundation_.________."-------Distance to nearest lot line----I-------------- <br /> Seepage Pit: Distance to nearest well_.___.,...____--------Distance <br /> F1 Number of p*jfs-----------------------Lining material-----------------------Size-. Diameter--- •-------------------Depth--------------------i f------------ <br /> Cesspool: Distance from nearest well_________________Distance from foundation--- ----------------Lining material"_.________._______--_1------------- <br /> Liquid Capacity_.------------------1!-----gal,. <br /> ElSize: Diameter------ ---------- --------------------Depth -----------------------—------------- --------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------- ------- <br /> II <br /> ElDistance to nearest lot line_ _______________ -------------------------------------------------------------------------------------------------------- -------------------- <br /> ------------------------------------------------------- ---------------------- ------------- <br /> Remodeling and/or repairing (describe):_____1_0----f"-----ed-—----- <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' aunty <br /> ordinances, State laws, and rules and regulations of.the San Joaquin Local Health District. <br /> nf <br /> -----------------------------------------------------------------------------------(Owner and/or Co' ractor) <br /> (Signed)--------- 0_1694 ij <br /> ------------------------------------------------(Title)--------- ---------------------------------------------------- <br /> By:------------ ------------------------------------------------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). :1 <br /> OR DEPARTMENT USE ONLY <br /> DATE------------ ---------- <br /> APPLICATION ACCEPTED BY-------------------------------- --- ----------------------- <br /> ---------------- ---------- <br /> --------------- <br /> REVIEWEDBY---------------------------------;--------------------------------------------- DATE---------- <br /> -1 . DATE—----------- ----------------- <br /> - <br /> ----- ---------------------- <br /> B�JILDING PERMIT ISSUED--------------------------------------------------- --------------- --------- <br /> ---------------------------------------------- -------- <br /> Alterations and/or recommendations: ------------- . .. ........ <br /> -------------------------------------------------------------­--------------------- <br /> ----------- ----------------------------------------------------------------------------------- ----------- - ------- ------- <br /> --------------------------------------------------------------------------------------------------------------- --------------------------------- -------------------------------------------------------------6-------------- <br /> ­­--------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- ----------- <br /> ---------------------------------------------------------------------- - --- ------------ -•-•------------ <br /> 4 <br /> -------------- I------------------------------------------------------------------------------ -------------- <br /> ---­------------1�--------- <br /> - --- ----- - <br /> FINAL INSPECTION BY--------- -------- ----- --- ---------- Date_ --------1-0--- - -- ------ - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Ste"t <br /> Stockton, California Lodi, California Manteca, California Tracy, California' <br /> ES-9-2M �o-52 Revised W-2100 <br />