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APPLICATION FOR SANITATION PERMIT Permit No. .-731.7--- <br /> (Complete in Duplicate) <br /> Date Issued ---- <br /> Application <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 Count Ordain nceNa 549. <br /> JOB ADDRESS AND LOCATION.-I r � ( _ - �- ------------------------------------------------------------------------ <br /> � r <I . � ------- Phone----------------------------------- <br /> Owner's Name- - r <br /> Address--------------- j�),,PI-°r f`' f` = <br /> Contractor's Name---(�"�u Q-.�i/------------------- -----------------------J Phone <br /> Installation will serve: Residence [Apartment House ❑++ 5 <br /> Commercial [-] Trailer Court E] Motell E] Other/fO�thher E]__(- <br /> Number of living units: __I____ umber of bedrooms .___ Number of baths _1---- Lot size _�--X-1-F_ _0- ----- <br /> --------- ----------- <br /> Water Supply: Public system Community system ❑ 'Private ❑ -Depth to Water Table _______ ft. <br /> Character of soil to a depth of 3 feet: SandE] Gravel ❑ Sandy Loam Clay Loam [] Clay E] Adobe�rdpan El <br /> Previous Application Made: Yes E] No V New Construction: Yes L� IVO ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if_ ublic sewer is available within 200 feet.) <br /> - -�P i <br /> Septic nk: Distance from nearest well _,._"�JDistaace fro fou lationff)7 Mat r'ial---------_---- __ ____ ______ -.___. <br /> M14No. of compartments y� � ---Size a Liquid. depth. t Capacity-- <br /> --- <br /> apaci#Y <br /> _______ <br /> DispTos�al eId: Distance from nearest well±' ' , Distance from pur tio�-�F'- Distance to nearest i a__ _�!-`-- <br /> L� Number of lines___________ 12--- _.-.-Length of eac 11r�e____________--_ _ ' Width of french___ {__ .,_t ___ , <br /> f �& 47 <br /> Type of filter maters&__-_�>��- _Depth of filter material___-__. _________Total length_______________ __ �O____ <br /> f <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------------...Distance to nearest lot line_-_-______.______ <br /> ❑ Number of pits----------------------Lining material---------------------- Size: Diameter-------------------.---.Depth--------------------------------- <br /> >"" <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 /> Re oda ling and/o, repairing Mescribe):------------------ ------------------------------------------------------------------------------------------------------------- --------- <br /> -•-------------------------------------------•----------------------------------- ----------------..------------------------------------------------- <br /> --------------------------- <br /> --------------------------------------------------------------•--------------------------------------------------------------------------1­------------------------------------------------------------------------------ <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�l6es, and rWles and regulations..of the San Joaquin Local Health District. <br /> 'Ir001 <br /> (Signed)_______ � � - ._ ___.(Owner and/or Contractor( <br /> By:------------------------------------------- -------- - ------------------------------------ ---------(Title)------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side), <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED-BY ------- = DATE- -------------------------------------------- <br /> REVIEWED BY----------- ------ ------- DATE <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------- <br /> . <br /> -------------------------------------- <br /> Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------• ----------------------------------------------------------------------------------------•---•------•-------•-----------------•- ---------------------- <br /> -------------•--------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------------.------ <br /> ------------------------------ ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------•--- <br /> FINAL INSPECTION BY: _ _.___-1 --- ---------------------- Date.... -1--=`-- - --------- ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9--2M Revises 1.57 F.P CO. <br />