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pos�/q 3-0y4 <br /> APPLICATION' FOR SANITATION PERMIT Permit No. _11.L'. <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica+ion is hereby made to the San Joaquin local`Health district for a perms+ to constr an i stall the w`""o herein d i� <br /> This application is made in complia with Cou y Ordinance-No. 549. • �• 700) <br /> �- ----- -- - - <br /> Ip <br /> JOB ADDRES AND, ` OC TjIO � ---i� --------- • - --� ----------------------- <br /> Owner's m ------ --- - ----- -- ------------------------------------ ------------ ---- hone------------------ -•----•--- <br /> .,i <br /> Conteactors Name-- -- --- -•--•- --------- ---- -- ----------------------- ----'-'-Y---- ,_. _ -------- -----••------•------------------ Phone-------------------................. <br /> Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Mote ❑ Other D: <br /> - Y <br /> Number of living units: _�._--- Number of bedroomsc --_Number of-baths ..�___ Lot size ___ 12V fik,1419:: <br /> Water Supply: Public,System" '❑`4Community system'❑Privato Depth to Water Table<1ay <br /> ft.Character of soil to a depth of 3 feet: ` Sand Gravel E] Sandy Loam Clay Loam ❑ Adobe❑ Hardpan E]Previous Application Made: Yes E] No New Construction: Yes 56 No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i <br /> [Na septic tank or cesspool"permi++ed:if publigsewer i available within 200 fees )� <br /> Septic ank: Distance from:nearest weIIQ�I,I.^____ ista ¢e from oun t�onfL!__=_.______.MaterJ'a ___�._�_______--_�_ _ <br /> No. of,compar.,tments f _tSiz Liquid repth -Capacity CC <br /> Disposal Field: ' Distance from nearest weI1Q_.___._ istance from Foundation_/ __ __ _._._ istance to nearest to li _ 1rJ_ ti' ! <br /> O.�_ '-f <br /> Number of lines__________ _ ____ __ .Length of each line________.a _ Width of trench._- .___..__-_..._ <br /> Type of filter maters {_ _. ______ e th bf filter material____-__1_ �_.Total length______________ Q_._________I_. <br /> $cepa e Pit: Distance to nearest we l4�_r�pa.___ Distant f oun anon___..• --�t__._.Distanc to nearest lot li <br /> -- f ry <br /> ,; i � f fir/ .{------------- <br /> Number of pits-----_-{ --} .� Lining material �i✓S I__ - e: Diameter------a�C -'-_--Depth----- e ..__._ <br /> f: ' --- i t <br /> Cesspool: Distance from nearest well-----------------Distance from foundation:-..-----------------Lining material-------..'_.___.____._.__--____._____ <br /> Size.: i]iameFer-----------------' ---'= :Depth -----`- ',.._Liquid;Capaci#Y = gals.- - <br /> Privy:' ' Distance from(.nearest well----- <br /> --------------------------------------------Distance from nearest building-'-.--.-----------------------------------. <br /> ❑ """ ". . '-+-Distance to nearest;lot'line-------------------------- *. . ---� --------- W------------------------------------ <br /> ----- -' .... ............'....-- ---........... <br /> Remodeling and/oc repairing (describe.)_--------------------------- <br /> - } <br /> i <br /> ______________________________________+___.__.___________._...________....________....________.__.. <br /> IFhereby certify that I have prepared this application and that the work will be done'in accordance with San Joaquin County <br /> ordinances, State laws, and rules and,regulations of the San Joaquin Local Health District.' <br /> (Signed)7?, '-----t-- � '- -- ----------- - - -----(Owner and/or Contractor) <br /> INAi <br /> BY:•_------------------ --------- ---------------------------------------'--------------- -•---------=-------._(Title)---- -------- ---------- <br /> [Plot plan; showing size of.lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> - FOR DEPARTMENT USE ONLY <br /> F _ <br /> APPLICATION ACCEPTED BY- ----- - - --------------------• ----------------- ------------------------------------- DATE_��----- ...' - - <br /> REVIEWED BY ---- --- -- ' = - DATE - <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------- ------------------•--••--------•-- DATE---------- <br /> Alterations and/or recommenda.+ions:-- -_-'-------------=------------=-------------•-•- ----------------=---- --------------•-•-----.........----••---•------ -------------------------- <br /> 1 , , <br /> --------------------------- - <br /> : t -----------.------------------------------------------------- <br /> ---­---------------------- ------------------------------ -------------------------------------------- = --------------------- ------------------- <br /> ------------------------------ <br /> ; <br /> t I <br /> --------------------------- ------ -- '--------------------•- -- ----------------- - -- -- - ---- <br /> _- 7 7: -- <br /> FINAL INSPECTION BY::- = ------- —~-~Date- = = ._ �. ._ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1 <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Streef ^t <br /> Stockton, California Lodi, California Manteca, California Tracy, California r `3 <br /> ES-9-2M Revised W-2100 <br />