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FOR OFFICE USE: jA10q9 Yu <br /> APPLICATION FOR SANITATION PERMIT Permit No. / ....... <br /> ----------------- ------------------------ (Complete in Duplicate) <br /> ----------------_---------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS A LOCATIOO --� ------------------------------------- - -•l.lr '`'''"d'r�' <br /> Owner's Name.............. --------- -------------------------------.........Y-- Phone------------------------------- <br /> Address----------------------- -- ----- - f=---- - -- .................... ...-•-----•------------------•--------------•--••-------------------•----•---.... <br /> Contractor's Name---- -- -- •... ••-•-••-----•--•----------•-•---------------- ------------------................................................. Phone................................... <br /> Installation will serve: Residen Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .._--- Number of bedrooms ..A-. Number of baths j---- Lot size --------&AX-1.0.jo......................... <br /> Water Supply: Public system ❑ Community system k Private ❑ Depth to Water Table .14 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay k Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: 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 well. istan a from foun,�tion.....ID.........Mat ri . ---- <br /> No. of compartments_________....-_.._Size_ _/ X__.S......Liquid depth_-_... .-_f- _Capacity._�.ZC4t___ <br /> istance from foundation.. ..Distance to nearest lot line <br /> Disposal Field: Distance from nearest well_Q�'� �- ---�-� --- � �� �- <br /> Number of lines.__.rrZ____________ __ ____ __Length of each line_..,.__�._�'. �C Width of trench...:- __.. ,$_..____- ...... <br /> Type of filter material-' 'e.Depth of filter material-_ ----..__Total length___. ___________________________ <br /> See age Pit: Distance to near t w `` from foyn .o .._.... fi tante to nearest lot line--- ........... <br /> V <br /> "- Number of pits___I---------- materi)�.1'IIr! ._ .. ___ �Diame a __ !"__Depth-.___._ _ _--------- <br /> Cesspool: Distance from nearest well.................Distance fro foundation___________---.--__.Lining material------------------------------------- <br /> Size: <br /> _-__-__----_-.-._-_-__-___--_-----_Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well ___-_________________________--.____.--------Distance from nearest'building__________---_________-----_-__._______-. <br /> ❑ Distance to nearest lot line-----------------------------------------_-•------------------------•--------•----------•----•---•-------•-------------•-•-------------------- <br /> Remodelingand/or repairing (describe):----------------------------------....................................................................................................................... <br /> .............................................................••-•----•-----•---•--•••--------------•-------•---•-------------------- ----------•-......--••-•-------•.----------•--••-----•--•--••-----------------------•--• <br /> --------------------------------•----•-•------------------------------------------•-------•-------------•------------•------------------------------•----------•---------•------•--------------------------•-•---------------- "V <br /> ----------•-------------------•-------------------------------- ----------------------------------------------------------------•-----------------•-----------•---------------------•-----------•-.-------------------.----- 0 <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la s, and rules an regulations of the San Joaquin Local Health District. <br /> 91 <br /> 51 ned ------------------------------------------------------(Owner and/or Contractor) <br /> By:_--- ------ - ---- ----------- ------------- - - - - - (rifle)------------------------------------------------------ ---- <br /> (Plot plan, showing size it lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------ ---- --- ---------- --------------- DATE------------------------------------------------------------ <br /> ----- <br /> BY------------------ - •----- DATE `. _. <br /> BUILDING PERMIT ISSUED ... <br /> ---------•---------•-•---- DATE <br /> Alterationsand/or recommendations:............................................................................................................................................................... <br /> ---------------------------------------------------------------------------------•------------------------------------------------------------------------------•--------------------------•-----------......._...---------- <br /> ----------------------------------•------------------•-•-------••--••------------•------------- -------------------•----••--•--•----------------•-••---------•••••--••-•-••---•----••-----•----•---•-•---•-••---•---•---- <br /> -------------------------------------------------------------------- --------------------------------------------------------------------------------------------­------------------------------------- ---------------•- <br /> -------------------------------------------- ------ ------------------------ ----- --------- --•------------•---•--------••••--•--- ----.. . <br /> FINALINSPECTION BY------------- ------ Date-------------------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EX-9 REVISED 6.69 F.F.CD.2M 6.60 <br />