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iS Jz APPLICATION FOR SANITATION PERMIT Permit No. ,E _4-+------__ <br /> V (Complete in Duplicate) <br /> Date, ssued --- -------- <br /> A <br /> _L <br /> Appc—atl ion 1s hereby made to the San Joaquin Local Health District for a permit to construct and install the_w k her'i described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LO ATI ___---_- -- ---------+ !-------_�_-` 'I :-- -------- 1 4 <br /> / ---------- <br /> / ! ---------- <br /> Owners Name-------------- i E"" `--------- f---y �� ?_ <br /> Address------------•- -... * ------ ------------ ---------------------------------------------------------------------------------- <br /> Contractor's Name_._ .__ i <br /> ------- -- -� �_f_..���� Phone �"' �� <br /> Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1____ Number of bedrooms J--. Number of baths j_____ Lot size ____6eX____ ____-________________ <br /> Water Supply: Public system ❑ Community system ❑ Private ( Depth to Water Table__ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan E]Previous Application Made: Yes E] No V New Construction: Yes No E] ' ` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ello <br /> Septic Tank: Distance from nearest well____-____ Distance/from/foundation__i!,?_______-__.Material_______ ___ ____ _�C7;flf- <br /> No, of compartments----�---------------Size_S'6_njIA-X_D Liquid depth----%�------------Capacity__90�_a=__ <br /> // ►� <br /> Disposal Field: Distance from nearest well__C4�-___- Distance from foundation__--_-----Distance to nearest lot line_,--'________ <br /> Number of lines._-er ___ _-_______ Length of each line____ '4_ Width of trench __ _________________ <br /> Type of filter materialJr ____ (11�__Depth of filter material_____ - __ - Total length______fes_'_______________________ <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line----------------- CA <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- V <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------_--------_--Lining material----------------------------I........ try <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. V 1 <br /> Privy: Distance from nearest well-----------_-------------------------------------Distance from nearest building--------------------------------------- <br /> ❑ Distance to nearest lot line---------------------------------------------- ------------------------------------------------------------------------•--------------------- <br /> Remodeling and/or repairing (describe): -- <br /> ---�— -- <br /> 'ep <br /> F <br /> j <br /> --------------------------------------------------------------- -------------- ---------- ------------- <br /> ------------------------------------------- <br /> --- - <br /> -------- '� --------------------------- --------------------------------------------------------------------------------- <br /> I hereby certify that I have pre red this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances,,S ate laws, and rules d regulations of the San Joa uin Local Health District. <br /> R:--- -•_ _--!---- f1-�- -- -- - _ �- Owner nd or ontractor <br /> (Signed) ( / ) <br /> l� I Title + <br /> -- ---- - i!,! ----------------------- <br /> (Plat plan, showing size of lot, location of system in relation wells, buildings, etc., can be plat on reverse side). <br /> Jf MENT USE ONLY <br /> APPLICATION ACCEPTED BY____________ __ .- DATE <br /> c _7 <br /> - - - ------------- DATE-------------------- <br /> REVIEWED <br /> --� �----------------- <br /> - - - - - ---------------- <br /> REVIEWEDBY---------------------------------------------- -------------------------------------� --------------------------------- DATE---------- + <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE <br /> - ------------------------------- <br /> Aiterations and/or recommendations----------------------- --- ----------------------------------------------------------------------------- <br /> ---------------------------------------------------------•------------­­--- ------------------------------- ---------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------ ------ <br /> ----1-- <br /> -- ----------- ------------------------------------------- <br /> 1 (� / 2 <br /> FINAL INSPECTION BY:-- ---------' f..l---�-------- ------------ ----- Date- --- ----1 - �44 --;�-- --------------- <br /> SAN <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 Mantecar California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />