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APPLICATION FOR SANITATION PERMIT Permit No. ....i�_l <br /> (Complete in Duplicate) Date Issued .! ,3•_s <br /> Applic6-1-ion is hereby'made to the Son 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 /> JOBADDRESS-AND LQCATION.. .... .................. . .. ... ...... .. .................................................................... <br /> 1, oe— <br /> ....... .......:................................. Phone........Owner's Name.... ------------------ <br /> Address............I i. ........................................................................................................................ <br /> ------------ <br /> Z:7 <br /> Contractor's Name......!Dfi-ll........ ------ <br /> ............................................. Phone.&CIL-6--9.4-0.7 <br /> Installation will serve: 'Residence,3 Apartment House E] Commercial E] Trailer Court 0 Motel 0 Other E] <br /> Number of living units: I.... Number of bedroom's ­,-Number of baths ...J. Lot size ....... .................... <br /> Watei Supply:� 'Public system'a- C6m"munify system El Private F-1 Depth to Wafer Table <br /> Chara I cter of soil to a depth of 3 feet: Sand F <br /> Gravel E] Sandy Loam; C] Clay Loam ❑ Clay E] Adobe Hardpan <br /> Previous Application Made: Yes-E] No [& New Construction: Yes E] No J& <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fank'or-cesspool permitted if public sewer is available within 200 fee+.) <br /> Septic Tank -4jrom nearest well................::Disfance from foundation....................Material.....------------------------------------------- <br /> ❑ -Is..... .............'Size......._..No. of Oompairtmen ....... .................­Liquid depth.........................Capacity----------------------- <br /> Disposal Field:. ...Distance' from nearest well.-Z?b%L.D isfa"rice from foundation.... Distance to nearest lot line_.;;;rP0..... <br /> Number,of lines_.....(.. .._....... "Length of each line.......... . .....7...Width of french.-­­*... <br /> material._./.-T.___-'�ADepth �.f filter material....... g 1, .........Tof6l length--' -J.......... )J- <br /> Type of'filfei ------f2z,.4-77 <br /> Seepage Pit: 'Distar;ce to_nearesf'well__'. f unda ion.... ........... i:st ce to nearest lot line.*____-5------ j <br /> gXU Fo r <br /> Numbe of its.............. .....Lining rt�iaferiafc�............... Diametet-2..... • <br /> ..............Depth----- . ....... 0 <br /> p <br /> Cesspool: Distance from nearest well...............2Distance from foundation..............:.....Lining material........._............._............. <br /> ❑ <br /> Size: Diameter.... ....... ....................Depth------------------------- ................ .........Liquiid Capacity............................gals. M <br /> Pr;vy-I Distance ',from nearest well......................*--------*-----------------------Distance from nearest building._;_.. . ....... <br /> ❑ Distance to ....................................I.................................................................... <br /> Remodelingand/or repairing (describe):-.'........................ ............ ------------------------------------------------------I-------------------------------------------------------- <br /> .................................................................................................................­............................ ................................................................... <br /> -. f t E <br /> ............................................................................................. ...............1.................................................................................................... <br /> ...................................... ......I..................................................... ........................... ............................................................................................. <br /> I hereby certif I have-p'repar'ed pirepar'ed f hiis application and that the work will-be done in accordance with San Joaquin County <br /> ordinances, Statenas,"a' d rules and r'egulaf16ns of fhe�San Joaquin.Local Health'District:' <br /> . ........................................ Owner and/or Contractor) <br /> __---------- ........... <br /> (Signed)-------------;;:7---1. .- <br /> ..?A. <br /> ... (Title)... ............................ <br /> By:... ------------ --------- - ----------- ------- .......(Title}_..---._­:!:!� --------- <br /> (Plot Plan, showing size of lot, loaafiori,6f system in relation'to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY . <br /> APPLICATION ACCEPTED BY............* ....... -­------------------............................ DAT k....... -------- <br /> REVIEWEDBY.................................... .........................................................-•-------......_ DATE--•• ..................................................... <br /> ............................... <br /> BUILDING PERMIT ISSUED..................:..........•. ....zN..A DATE............ ...... ..........................:........ <br /> .......................................1­......... <br /> Alterations and/or.recomrn' endations:.....'.............................. <br /> -------............................................­.­.............. .......................... <br /> -­---­-­­-- <br /> ------- <br /> ----------------- ... •-•-•-•'--••---.--......_....f <br /> ......i----------**"**-*........... .............•------------------------------------------------------------------------------------------- <br /> . ..... .............................................................­­............... <br /> .......................................................................................................... <br /> ............ ....... <br /> ..... ........ .. __ . I <br /> ............. <br /> ---------------------- <br /> ..... .... ... ........... ......................... -------- ------ ............................................... ........................ ...... <br /> -------7n... -Dafe._:7�-----------------------Ste:....................................... <br /> FINAL INSPECTION'-BY:::" ......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stock+an, California Lodi, California Manteca, California Tracy, California <br /> ES-9--2M Revised W-2100 <br />