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APPLICATION FOR SANITATION PERMIT Permit No. __l-(1_ •_a <br /> (Complete in Duplicate) � <br /> ._, ...r9. Date Issued --- <br /> Applica#ion 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 Ordina,ce No. 549. <br /> JOB ADDRESS AND-LOCATION!.-,_:__�{ •f'__ �/ <br /> _.------------------------ <br /> Owner'sJ` r <br /> Name-------------�,r'�'YS�-----=V 1-1r r^y�. a _ -- ------•-----------•------•- --------- <br /> Address-------- /� r ------------------ Phone <br /> Contractors Name.-----•---_¢-t -------•---- <br /> - <br /> Phone---- <br /> ------------- <br /> Installation <br /> will serve: ResidenceP <br /> ® A artment House ❑ Commercial ❑ Trailer Court <br /> ❑ Mote! ❑ Other <br /> Number of living units: 1Number of bedrooms __l-___ Number of baths __I--_ Lot size ._ �-k t.2 r ❑ <br /> Water Supply: Public system } '------------------------- ------•- <br /> Y Cammuni# system <br /> Character of soil to a depth of 3 feet: Sand Y Y Grave) PrlSend �oaDepth to Water Table __._____ ft. <br /> ❑ Y Clay Loam n - Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑, No New Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �NO ❑ FHA/VA, Yes ❑ No ❑ <br /> (No septic tank or'cesspool permifted'if public sewer is available w1thin`200 feet.) , <br /> -Se tic Tank: <br /> P Distance.from,neares:t,--well_____-__:_---­Distance-.from=foundation_________________".Material----------------------- <br /> Disposal <br /> _______-____.-_ - <br /> ❑ No. of compartments--------------------------Size-- -- <br /> ------Liquid depth-- Ca,pacify----- -------- <br /> Disposal Field: Distance from nearest well__----_------_-Distance from foundation___-__•____-_______Distance to nearest lot line----------------- <br /> Number of lines_�---------------------------------Length of each line-----------------------------"Width of trench------ ---"--- <br /> Type of filter material-_______________________Depth of filter material-________"___. ---`----------""""""C <br /> Seepage.Pit: -----Total length------------------- <br /> Distance to nearest weli___-_______--"__--__-Distance from founda#.ion______._____ ------------------ `� <br /> ❑ Number..of.pits_ _--- Distance to nearest ' <br /> .--------Li�•ning:material--------:-------------Size:zDia:Size. ---=--_-----------_-Depth to line <br /> Cesspool: ; Distance from ne est - - ° <br /> elh"-' Distance from�foundationl '°^� ,r-_ Lining material-_f�{---_- <br /> �y .� , r <br /> IA1 f size: aar*rehCr <br /> = ---------------- <br /> ---- -- Depth------ <br /> ---------------------------------------Liquid Capacify -----------------Privy: r , � Distance from nearest well___-,."-_-: '- --___---"-_ ga'• <br /> __._Distance from nearest building <br /> +❑' :�- .. Distance to nearest lot line------ g --------- --------------------- <br /> ------------�---- ------•--- ._^c_�------------ ------- --- <br /> a <br /> �sc <br /> s ------- �---- <br /> = _ ---- <br /> -------------------------- <br /> ----------------•---- is . ------------------- <br /> --------------- <br /> ----------------------------------------- ------- ----------------•-------••---------.--------------•------------- ----------------------------------- <br /> ordinances,I hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County <br /> te Taws, and rules andregulations of the San Joaquin Local Health District. <br /> (Signed)--------- ----- ;�, <br /> B 5 { -------------------- --------------------(Owner aa4:/�rr-C #rrtbr�` <br /> Y� ----------- ---------•----------------------- -------------------------- <br /> (Plot plan, showin size lot location of system in:rela#ion to wells, buildings, (Title)______:___-___ <br /> g o -- -•----------- e- <br /> retc., can-be placed on reverse side)," ' R-DEPAR- SE-ONLY _ <br /> APPLICATION ACCEPTED BY__'- <br /> REV -_`-_ ---__ --_•- <br /> IEW£D BY ----------- DATE_._._ <br /> ---------------- <br /> BUILDING PERMIT ISSUED---------- <br /> - ----�- ---------- ---�- ------- -- <br /> ------- DATE-------------------------- - <br /> Alterations and/or recommendations:_.:_ DAT£__________________________ <br /> ---------- <br /> --------------------- <br /> ---------------------------•----------------------------- <br /> ------------------------- <br /> ------------------------ <br /> FINAL INSPECTION BY--------- -------.-----"---- - -- - <br /> Date <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American sire®+ 300 West Oak Street <br /> 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California � . ` <br /> � _- Manta , California <br /> ce Tracy, Callfornla <br /> ES-9-2M : Revise6 1-57 EP.CC. <br /> . — <br />