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2d~ 0 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..,/._,e _T --__ <br /> (Complete in Duplicate) <br /> p ) Date Issued ____�/r q( <br /> 1 �.�Applita+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 /> t. JOB ADDRESS AND LOCITION___ _ ___f_ 4 Ala- _ _ errs <br /> ° <br /> Owner's Name-------V �I � /� -- - <br /> _ . -- <br /> Address................ -------- ----------•-------------------- •--------- ................._ Phone_3 ---- <br /> ----------- <br /> ---------------------�-W�t4Q------- <br /> Contractor's Name------------- I------------------------------------------------------------------------------------- - -- ------ Phone <br /> Installation will serve: Reside nce. W Apartment House ❑ Commercial Trailer Court <br /> ❑ ❑ Motel ❑ Other ❑ <br /> Number of living unil. ._/___ Number of bedrooms __:j Number of baths -_/___ Lot size ..../- .Pew <br /> - --------------------------------------- <br /> r <br /> Water Supply: Public system ElCommunity system E] Private W Depth to Water Table -----___ ft. 70 we 11 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 1R Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ I <br /> Previous Application Made: Yes ❑ No ER New Construction: Yes 91 No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> aseptic flank or cesspool permitted if public sewer is availeb�e withio`200 <br /> Septic Tank: Distancefrom nearest well-----6-0_ Distancey from, foundation----/4------- f 7° <br /> ® No. of c i mpartments.---------k---------- Size . ,- Liquid depth----- ------- -----------Capacity------_F--- <br /> Disposal Field: Distance from nearest well---6n.r------Distance from foundation----A�D.__.....Distance to nearest [of i <br /> line_.$_! <br /> Number poi lines---------2------- - - -- ---Length of each line-----�P-------y_------,,.Width of trench__-. -"---------------_-_ AA <br /> U` <br /> Type of filter material.0f. _.f --Depth of filter material___-?�.---�5-. Total length_____-/- <br /> �Ito <br /> - - ------•-----------•------ <br /> Seepage Pit: Distancenearest well______________________Distance from foundation_.______ <br /> .__________Distance to nearest lot <br /> ❑ Number of pits----------------------Lining material.----------------------Size: Diameter__-.-------------.._._.Depth------------------------.- <br /> Cesspool: Distancetrom nearest well________________ Distance from ion-------------------- material_._._-____._____._-_- <br /> -- <br /> ❑ Size: Dia eter------------------ <br /> 'r'.-' ----------- -.__-Depth---------------------------- ---- -------- ---Liquid CapacitY-------••---------- -------.gal4�_ <br /> Privy: Distance mom nearest well________-----------------------------------------Distance from nearest buildinT ❑ Distance o nearestilot line ---------------- g <br /> Remodeling and/or repairing (describe)-------------------------- <br /> ------•-------•--------•-•-----•---------•-------- <br /> --------------------- ----- -- <br /> 1111 <br /> __________________________________________________ _______________________________________________________________________________________________________________________________________________________________________ <br /> I hereby certify that I halve prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)..__.__- - <br /> = ------------------ ------------------ ---------- ------------------------------------- ---------•---------------(Owner <br /> :.$Y- = ____.._._- _ .9-----_------- -- .; ITitle� _ ..+and or Contractor) <br /> g -: - <br /> (Plot plan, showing size of lot�Glocallion of system in relation to wells buildin s, etc., can be placed on reverse side). J <br /> �FOR.DEP RTMENT US ONLY <br /> APPLICATION ACCEPTED BI <br /> ------ --------------------•--------- ------------- DATE. ' ----------------- <br /> REVIEWED BY------------ - ....... <br /> -----�- - ------------ - ---------------------------- � - <br /> ---------------------------------------------- DATE--------PERMIT ISSUED ,�-- ------------------------- --------------- ------ DATE <br /> -------------------------------------- <br /> Aterations and/or recommen�p tions:___.__............................. <br /> ••-----------------------••----------------------•------------------------- --------------- ------------------------------------------------ <br /> - <br /> ------------------------•--•--------- •---- -----------Q_ ---------------------------------------------------------- -------------- ---------•---------------------•----•--------------•----- <br /> -- �-- <br /> ---•--- ------------ ----•- ..-- �p-------- ------•-- --------------- ------------------------------------------------------- -------------------------- ------- ------­­--------1'�---------------- <br /> ------------------------------------------------- <br /> --- <br /> - -- ---------------------------- <br /> ---------•----------------•---------------------- <br /> ------------------------------- <br /> FINAL INSPECTION BY:_.__. ..._. - - <br /> - - ------- ----------- •----------------- - Date.--------/-- -•- �-- ---� -�------------ �- - <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 /> ES-9-2M 14SA46 ar Waoo lz-sa <br />