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%5-7 - �7 S--- o�3 <br /> �,�• ` APPLICATION FOR SANITATION PERMIT Permit No. ._.1 ..___.�... <br /> ` ✓" 1 _ Vad-Iscribed.Com lefe in Du licate g ! P p } Date Issued _. 5----AppIicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei <br /> This application is made in compliance with County Ordin ce No. 549. <br /> 10-4140 <br /> JOB ADDRESS ANL+OCATION .....• - .r..... ,� �. <br /> Owner's Name ` _/ I...... . .. ..... . ... --•--•---••--------••-----•----- ---....................._.-....--- ----------------- Phone---rf----�- --�------ <br /> Address------- >s?_ P [,L�(�'1!1..�. �j._...... <br /> Contractor's Name__ .. ....... . . � -•-• ___Q_7—5- 1?,d-d2f_ �_ ----.................................................... Phone ... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercialx Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ... Number of bedrooms _.._ _ Number of baths -------- Lot size ----...__3,Z'_X_----_ .a- ----.----_ <br /> Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table0� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes No E] , a <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Tank: Distance from nearest well_.'. Distance from foundation... ------ 4- <br /> Septic _...................... r-... _ <br /> Pio. of compartments.......-_.ate-._..----.--Size_. IP._ _y� _.___Liquid depth_.._._`5----._?r--___._Capacity.... _..-. <br /> Disposal Field: Distance from nearest well...?7- Distance from foundation._.._ .._.Distance to nearest lot li _.er..... Q <br /> Number o-i lines-----------/...- Length of each line--.-_---3.d_�__.;�_--_.Width of french.....�-�1.i'f................ <br /> Type of filter material_.S'1_ b. ._.Depth of filter material-----W--_----..Total length____3q...... <br /> i <br /> Seepage Pit: Distance to nearest well.../---__-____Distance from foundation_..... ._._.Distanceto nearest lot lAe.-.3 <br /> Number of pits.....-�...........Lining material_-Si_R.�lCSize: Diameter__-.._.�_�:------- Depth------- ----------------- (� <br /> Ce spool: Distance from nearest well---.--.-_-__--_-Distance from foundation_ __ -----Lining material__.-------------A---------- <br /> -- .__._.. <br /> -Li Liquid a <br /> ❑ S+ae: Diameter...............•----•-•----•-------- Depth----- ---------------------- -----------•--------- q CPaci tY-------------- ----------gals. <br /> Privy: Distance srom nearest well....-_:.......................__________________Distance from nearest building------_-------------___.____-.-.-- <br /> ❑ Distance to nearest lot line------------ --- ---------------------------- --------------------------------- ' <br /> R modeling and/or pairing fdescribi:):__�1 _ _ _ _-- �-..__._ �' .............•--- e._.I-------------------- <br /> ..., t. + ---------- <br /> -------------------------------------------------=-, I <br /> -................... ...........---------------------------------------------------- -------------------------------------------.-....-----------_-----...--•------•--..-- ---- <br /> I hereby cerfify thaf I have prepared this application and that the work will be done in accordance with San Joa l uin County <br /> ordinances, State laws; and rules and regulations of the San Joaquin Local Health District. <br /> (Signed). ............... --:- --------- - --.._......--•--...---•----•--........-------•----...._..............-- ----------------------- ---- ------( wrier and/or Contractor) <br /> B W � - Ti+le <br /> Y• cr.,2 ------------------------------------------------( ) - - <br /> (Plot plan, showing size of lot, location'of ystem in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY 1 <br /> APPLICATION ACCEPTED BYl <br /> DAT _ i... <br /> REVIEWEDBY--------------------------- --------- --••--••-••---....-- ----------------------------------- DATE_-- '-------------------- <br /> ------ <br /> BUILDINGPERMIT ISSUED-----------------......... ------- --- ----------------------•-------------------...------. ....... DATE --------- <br /> Alterations and/or recommendations:--.............. -K <br /> --- --- <br /> - - ------------ <br /> -------------- ---•---•-----_----..----•---•---•_.-- ------.-•-------- -----------•--.--------- -•-------------------------.-•--•------••----••---•-•----.......----•-------•--•--------.....- <br /> ---------- <br /> ---­------------------------:---------------------................. ----------------------------- ------------------------------------------ <br /> I <br /> I <br /> ,! . <br /> ----------------------------------------------------------------------- ....-----• ............. <br /> FINAL INSPECTION r ................ Date..... <br /> .. ___ <br /> SAN <br /> r <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sfreet 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 />