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APPLICATION FOR SANITATION PERMIT Permit No.�........... .......... <br /> (Complete in Duplicate) <br /> . Date Issued 6.....!2-_.. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de ribed. <br /> This application is made in compliance with County Ordinance No. 549. Z{ 2_ 400 <br /> t J B ADDRESS AND LOCATION....1..74Vf'" O-q --------••---------_.. <br /> Owner's Name_...� W� s._......-�� ..j.-•-- Phone.................................... <br /> /� ------------ <br /> Address------J •'-_---•--•-- •••-•--•-----•-----------------------------------------------------------------------._ ------........_ <br /> ContractorsName ......... .........:........._.. .............................................................. Phone................................... i <br /> Installation will serve: Reside ❑ Apartment House ❑ Commercial ❑ Traile Motel ❑ Z.1-91. <br /> -- ..... <br /> Number of living units: ....10.- Number of bedrooms_.5�._ Number of 111e1rMs.,�.._ Sze ..___.._.___�. ' <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 Loamy Clay Loam[3Clay Q Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yas Ili No X, New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available-within 200 feet.) <br /> Septic Tank: .. Distance from nearest wail-:I_�.P_f'Distan fr m/f�oun Win. ..... ..Materi '...- <br /> No- of compartments-_._ ;,;..................size. r �_U _.Liquid dep __._.._ ___._- _._.Capacity.. <br /> Disposal Field: Distance from nearest Distance from fcundatioh_/ f .......Distance to nearest lot line...."... -. <br /> Number o•i lines.._._..__1.-._._ Length of each line..... Width of trench....,�,/o..................... .� <br /> . - /-.---••------- <br /> Type of filter material__JYl ..`L..CS�_Depth of filter material-------�_�........Total length......{5.0........................ <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 /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material.................................... <br /> _ <br /> C1 Size:_Diameter................................... Depth..._......`...--•--•-......----.::...:.........Liquid Capacity...................:..._. gals.� <br /> Privy: Distance from nearest well................................................_Distance from nearest building..................._...................... <br /> ❑ Distance to nearest lot line.......•../_........................................................_..............–........................................................... �y <br /> I <br /> Remodeling and/or repairing (describe):- �Z •.. +.�¢!r2r�, ..- <br /> - �,•rte,•-•- - - -� -• -• •- --�.. - -- - --- ----�.�. .lzJ.. <br /> 1 � <br /> A— ep 1 a pt i a i a Fe'with an Joaquin County <br /> ordinances, State jaws. and rules and regulations of the San uin Local Heath District, <br /> (Signed)__._--.--. s.. s.._ (Owner and/or Contractor) <br /> I <br /> Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, eta, can be placed an reverse side). <br /> e <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--------t................ -----••-------_-_--------••-------••-------- DATE---_-------------- ..........•---........... <br /> REVIEWED BY......................... ------- k --------- DATE:----- •�1-�. <br /> BUILDING PERMIT ISSUED----------------_-_-- W <br /> -- ---------------- - DATE_......{ .....---.......................................... <br /> Alterations and/or recommendations:................. .._ ...----------••--------... <br /> ....................................................... •-----......---------•--• . - <br /> •----•-------•--•-----•--•-•.......................•--------...-----•---•-=--•---•...................................................................................-•--•------..................................... <br /> t <br /> • <br /> FINAL INSPECTION BY:..........................._---_- -_ --------- Date.....--- <br /> I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> [30 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 10-52 Revised W-2100 <br />