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APPLICATION FOR SANITATION PERMIT Permit 33 <br /> t6Wica4-ion <br /> - -- ------------- -- <br /> (Complete in Duplicate) Date Issued is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> , his application is mede-in compliance wifh County Ordinance No. 549. ` <br /> JOB ADDRESS AND LO ATION. = = - -------- <br /> 1 / . <br /> Owner's Name....... ` � t ------ Phone_tVQ___`9.a=z_ <br /> ____ _________________k _ __ __ _ ..._...__ _._.._..__. -.___._._____..____._...___________ __ _ <br /> Address �i. '� F -----------­------- --------------------------------------------------------------------------------------.._ -------" <br /> Contractor s Name___ �_ s______ ___ __ ___ -�___ <br /> Installation will serve:h Residence P_ Apartmenf House <br /> ❑ Commercial ❑ Trailer :Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms _�- -Number of baths _f.._. Lot'size ___r _______________________ <br /> Water Supply:'Public,sysfe"m "� Comriiunity-system ❑" Private ❑ Depth to Water Table &A ft. <br /> Character of soil to a depth of 3 feet: Sand [j `Gravel ❑ Sandy Loam ❑ Clay Loani ❑ Clay ❑ Adobe 0_ Hardpan ❑ <br /> Previws Application Made: Yes ❑ No ❑_. New Construction: Yes ❑ No I& <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: , <br /> (No septic taiiiVor cesspool permitted if`public sewer is available within 200 feet:) <br /> - �i ��t <br /> Septic T nk- Qpnce from nearest well________________Distance from foundation...... <br /> _.:._.___..__.Material_______________.__._____..______________________. VJ <br /> ❑ pf of conipartmenits------------- is----;:Size---------------------�-----:---Liquid depth--------------------------Capacity---------------------• O <br /> Disposal Field,: `- :moi`tante from nearest well...;__.____.____Distance from foundation______---------------Distance-to nearest lot line---"_---__----. <br /> ❑ ' r of lines ----------------------------- <br /> ----------- ------;Length of each line-=-------= ------------€-----Width of trench----------------------------------- <br /> FT�y of'filter material--------------- ------:Depth of filter material--------=--------------Total length----------------.--.---- ------ V <br /> - 3. <br /> Seepage_-Pit: bis#ante to nearest:well_.__/__-_____.____-_4-Qistance from foundation_.:. ___ Distancefo nearest lot iine__ <br /> Iz- Number of pits_____..'___-___--__Lining mate ria lLDiameter__"_ r_ ___"_-__.Qepth_-- ________________ <br /> ,� I <br /> Cesspool; Distance from nearest well____,_.___"_.._:Distance from foundation_____„___ ____.Lining material____________________________________. <br /> 5rize: Diameter-------- -- -- ---De th------------------------------------:----:------ Liquid Ca acit --gals. <br /> ❑ p G p Y g <br /> �I, T , - , <br /> Privy: Distance from nearest well---"--- ­:------------ from nearest building _. � <br /> ElDisfance'to nearest`:'lot line`”" i .. --,--.--,. _► �� � <br /> - <br /> - -------- --------- ---- <br /> Remodeling .and_/or repairing (clescribe]­__l:.__'-------------- t-------------------=----°------------------=--------- -----= -•------------------------------•------------------------- <br /> Ip ,y} t <br /> ---------------------------------------------------•- --------------------------------------------------------------- ----------------------------------- -----------------------•---------•------------------------------- <br /> ---------------------------------- <br /> ------•------•-----•----------___________________________________ ---------------------------------------------------.----------_-------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------- <br /> Thereby certify'jthat 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 /> t - <br /> (Signed}.__..... ,. .15 _-------------------------------- ------ "-------- (Owner and/or Contractor) <br /> 1 <br /> B ' nJ Title c , <br /> Y• ( } <br /> 1 (Plot plan, showing size of lot, Ication of system in relation to wells, buildings, etc.,_can be placed on reverse side). <br /> j� FOR DEPARTMENT USE ONLY y <br /> APPLICATION ACCEPTED BY-------------------------------- ---- DATE------ ---lza <br /> BY --- F <br /> - . -- - _ DATE----------- N---�------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------ DATE------------------- �---��-----------------•-----•---- <br /> Alterations and/or recommendations----------------------------------- t ----- ------------------------------------------------------------•-•--=------- ----•----4- <br /> --------------- <br /> ----------------------- <br /> ----------------------------------'�' '-�-----------------------------: .------•------ .. _....._.__..__.... � --------•--------- <br /> Ia f _. _ --.... <br /> --- <br /> �c <br /> -------------- -------- --------------------- ------------------ ----- <br /> k 1 <br /> r -- <br /> FINAL INSPECTION B :. TTS-- ----==-------- -Date:____:- _J_- - , " <br /> SAN JOAQUIN LOCAL, HEALTH' DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ' I <br /> /ES-9-2 M ; Ravi lad W-2100 <br />