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�1��� i it <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) 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. <br /> This application is made in compliance with County Ordinance No, 549. <br /> JOB ADDRESS AND LOCATION_ _-_ <br /> -------------------------- <br /> Owner's Name----------------- <br /> Phone_/-6,_;:_5/, <br /> Address,--------------------- - ----------------------- <br /> ----------------------- <br /> ------- <br /> ----------------t-------------------------------------------------------------------------- <br /> Contractor's Name._- - ----ii - -------------------- --- Phone., <br /> Installation will serve: Residence R1 Apartment House ❑ <br /> I! Commercial El Trailer Court El Motel El Other 0 <br /> Number of living units: -1---- Number of bedrooms Number of baths __/--- Lot size <br /> Water Supply: Public system Community system E] Private E] Depth to Wafer Table A,(Oft. <br /> Character of soil to a depfh:'of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay [] Adobe CN <br /> Previous Application Made:- Yes [] Nd New Construction: Yes Ej No, . FHA/VA. Yes 0 Noj2( Hardpan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> pfic,T l�' <br /> Disfancellfrom nearest well-----------------'Distance from foundation--------------------Material--------------- --------------------- <br /> No. of compartments--------------------------Size--------------------------------Liquid clep}h-------------- Ca aci <br /> C, length____.__--________________________________ <br /> - <br /> - --------- <br /> DisfanceEfrom nearest well_____- --------Distance from foundation--------------------Distance to nearest lot line_______-,`_______- <br /> 15 Number'bf lines-- -------------------------------Length of each line------------------------------Width of french <br /> Type of filter material_____---___ Depth of f'Ifer material------"----'----------Total---------------Total lencjfh----------------- <br /> ------------------------- <br /> Seepaci Pit Distance 11 to nearest well-_-[` Distance from' foundation---J41 ance c, nearest------------Dist f f lot line-_j------- <br /> Number'of pits-__-_- -___-______Lining material--- -.Size: Diameter---- le <br /> 7_ - -----Dept --------------------- <br /> esspool: Distanceilfrom nearest well-----------------Diistanc`e from foundation--------- <br /> H ------------Lining material____-__._____-.__________- <br /> --- - <br /> ❑ Size: <br /> aterial------ ----------------------------Size: Diameter-- - -- - Depth-.-' I <br /> --------- -------------------------Z -------Liquid Capacity----------------------- gaL <br /> Privy: Disfanceifrornnearest Well--'­-----------------------I------------------Distance from nearest building--------------------------- <br /> .11 - ---------- - <br /> ❑ <br /> Distance to nearest lot 6e------------------------------------------------------------------------ <br /> Remodeling and or repairinli g (describe):------ �-------- <br /> ------------ ---------------•--------------- -------------------------------------------------------------------------------------------------------------------------I------------------- ------------------- <br /> -------------------------------------------------------------------------- <br /> --------------------------------------------------- <br /> ------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I h1ve prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws,. and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------------------ <br /> _(Owner,and/or Contractor) <br /> By:------------------ ---------------------------------------------- 7, <br /> ------r- (Tif le) <br /> 14%----------- J <br /> ------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,tefc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION A---�-C--C----E--P--T-`-E--D----6Y------------------------- - ------------------------------------ DATE_ <br /> REVIEWEDBY ----- -------------------------------------------------------------------------- DATE- <br /> ------------------- <br /> BUILDING PERMIT ISSUED__11----------------------------I-------------------------------------------------------------------. DATE <br /> Alterations and/or recommendations---------=--- ------0 <br /> ------------------------ <br /> ------ --------------- <br /> nj <br /> - --- ------ <br /> --------------------- - ------ -------------------------------------•---------------I - ------ <br /> � t- Z <br /> ------------------- -----------­----------------- --------------------------QQ1 _NE:C__rf__Q ---------- o- ........ <br /> ---------------- <br /> ------------------------------------------------- -- -- ------------ ------- ----- -- -------------------------------------------------------------------------------------------- ------- ------- <br /> --------------------------------------------------11 -- ----- ------------------ in <br /> (V----------- ­1--------I--------------------------­---------------------------------------------------------------------- <br /> FINAL INSPECT <br /> N BY:.-IF' - --- -- ----- ---- -- Date-------- <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 l Lodi, California Manteca, California Tracy, California <br /> ES-9-2M -('Reviseci 1.57 FACO. <br />