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S <br /> APPLIGAtIGN FOR SANITATION PERMIT., Permit No. <br /> w (Complete in� Duplicated <br /> Date Issued ------------ <br /> Applica+ion 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 LOCATIONS -------�r..- - - <br /> -------------------- ----- - 4` --•-------------- <br /> Owner's Name--------- ­- --- --- -- ---- -- ----------------------------- ------------- Phone.- ------ <br /> -- ----- - ---------- --------- <br /> Address. --- <br /> Contractor's Name----------------------------- ------------.-----------•--------------------- Phone-------.----------------------•---- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer. Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --q_ Number of bedrooms -A_ Number of baths -- ---- Lot size ---.------a!_ _-------------------------- <br /> Water Supply: Public system ❑ Community system [I Private 4 Depth to Water Table 550 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ `Sandy Loam ❑ Clay LoamClay ❑ Adobe Hardpan L] <br /> Previous Application Made:' Yes ❑ No New Construction: Yes,N No ❑ <br /> i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:Ei <br /> (No septic fa nk or cesspool permitted if public sewer,is available.•w.ithin,200..feet.) <br /> Septic Tank: Distance from nearest well_,_��b D tance from foundation----R---0- -.Material_-._.- - - -.: { <br /> No, of compartments-------�--------------Size..---�3X4.X_S------Liquid depth-------- -_.fir`----..Capacity----------------------- <br /> Disposal Field: Distance from nearest well.__-_5__ ...Distannce. ro�fo n ation-----j�d----.-.Distance to nearest lot line_---_--- <br /> ,�_.. <br /> Number of lines---------------I.---..-.-------Length of each,li6e:---- --- --Q---- -=---.Width of tranch----------- {------------ <br /> Type of filter material -_. Depth of filter material_.--.._A?ly---__Total length--------------------l�--F.._.-- 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_____________________.-- --_----_-,.Q" <br /> '1 <br /> ❑ Size: Diameter--------------------------- ------Depth-----------==---------'----------------------- -Liquid Capacity------------------- 9als.� <br /> r <br /> Privy: Distance from nearest well -:--- ---- --_.... .. .......Distance from ne`are'st building--_-----_-_--._------------_---_---------:A% <br /> ❑ Distance to nearest lot line_- -_-_----�---�-`--- -------------- ' <br /> r •-------------------------•-------------------------------------------- <br /> Remodeling and/or repairing (describe]---------- -------- -- �- ---------------•- --------------•-------------l - <br /> ` <br /> --------- -•------------ -•-------------------------------------------------------'-------•-------------- <br /> ----------------------------------- ---- <br /> k 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 and rules and regulations,of to n Joaquin Local Health District. <br /> (Sign -•-------------- <br /> - '----------- --------------- <br /> 3d) Owne d/or Contractor <br /> By:.....--------------------------------------------------y---------- -�-�-- ------------------------------------ - -----(Title-------- - - <br /> Plof_�lan, showm size of lot'�lacat�on o s stem in relationjci wef(s buidings, etc.,..can be placed on'reverse sidel. a <br /> FOR DEPARTMENT USE ONLY <br /> BY. ------------------------- ' DATE <br /> j REVIEWED BY DATE----------- <br /> APPLICATION ACCEPTED <br /> ----------- -------' <br /> BUILDINGPERMIT ISSUED------------------------------------------------- ---------•---------•----------------------------- DATE-------- -------------------------------------- ------------ <br /> Alterationsand/or recommendations------------------ ----•..!i----------------- - ---------------------------------------------..-.-..---•---------------=•--..-......---------------------------- <br /> ----------- <br /> --------------------------•----------- -------------------------------•-- -•-----------------------•------ -----------•-----------------------•------------•------------ <br /> - ==--- <br /> - <br /> -- ---- <br /> - -------------------------------- ----------------- ----------- -------------------------------------------------•--------------- <br /> --------------------------- ------------- ;! <br /> FINAL INSPECTION BY E --i . <br /> . Date ' ' <br /> ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North ••C•• Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9 145446 ATWCO9 <br />