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APPLICATION FOR SANITATION PERMIT Permit No.�11__/2-_3. <br /> (Complete in Duplicate) <br /> rr Date Issued --- �5 <br /> Application 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 LOCATION-----------------52Q. W+-- 8th. 5 k_-11 <br /> ----------------------------------- -------- <br /> Owner's Name---------- 4? ------------------------------------------------------------------------- ----- Phone-A7:3027----------------- <br /> Address-----------•-----•-•same �f <br /> -----------------------------------•------------------------------ <br /> •---------------------------------- <br /> .. <br /> Contractor's Name--------- _Del�a1----inQ------------------------------------------------------ z <br /> --- -------------------------- ------------------------------------ ----------- Phone-------�--.1955---------- <br /> Installation will serve: Residence Ell: Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --- Number of bedrooms __2... Number of baths ---I -_ Lot size ____.5Q;&145 <br /> Water Supply: Public system [ Community system ❑ Private ❑ Depth to Water Table _30- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay E] Adobe ® Hardpan ❑ # <br /> { <br /> Previous Application Made: Yes ❑ No ® New Construction- Yes [3 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----nCi-------Distance from foundation----- 0_.........Materiai---C-U7'le?lt---------------------- <br /> ----------__---- j <br /> [,2 No. of compartments-------2---------------Size----6-_'x_4_ -X4--------Liquid depth-------0----------Capacity---�Qo <br /> ----- <br /> Disposal Field: Distance from nearest well------------------Distance"from foundation--------------------Distance to nearest lot line--_-___--_..-._. �} <br /> El Number of lines-----------------------------------Length of each line------=---------------------.Width of trench------------------------------------- <br /> Type of filter material-_-----------------------Depth of filter material-----------------------Total length----------------------------------------- <br /> Seepage <br /> ------------_-----.-_---------__ -See a e Pit: Distance to nearest well---nO-------------Distance from foundation_--,�D__r........Distance to nearest lot line---5__-_-----_ <br /> [ Number of pits------1-------------Lining material-----br1ck__-Size: Diameter------3--------------Depth-------2Q-.--------:-----_-_ t <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Linii7g <br /> ❑ near • materia+--- <br /> --_-___---`.-�-'-------------.---------- <br /> El <br /> _.-__---. <br /> ❑ Size: Diameter <br /> ------------------Depth---------------------- -Liquid Capacity <br /> gals. <br /> Privy: Distance fromnearest well- <br /> Distance to nearest lot stkuding.'------------------------------- -- <br /> ---------------------------------------- <br /> -------------------•--------------------- -------------- ------------------------------------ ----------------- <br /> Remodeling and/or .repairing (describe)-------------------New-------------------------------------------------------------- <br /> ----------------•------------••--------------------------------------•-----------------------•- •------------•--•------------•-------------------------------------------------------------------------- <br /> ----------------- ---------------------------------------------•-------------------------------------------------------- <br /> 1 hereby certify that P 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 /> 1 <br /> (Signed)---------De3_t&,__--1X-0-•---------------------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) l <br /> By: -------------------•----------------------------------------------=--------- -----(Title)----- Gen. Afar• ' <br /> ----.- ----- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> F RTMENT USE ONLY . <br /> APPLICATION ACCEPTED BY------------------- ------ - - --------- ---------------------------------------- DATE----- <br /> REVIEWEDBY -------------------------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED----------•------------------------------------------------------------------------------------------- DATE <br /> Alterations and/or recommendations:------- ----------------------------- ----- <br /> --- ------------------------------------------------------•-------------------I-------------------­-------------------- --------- <br /> ------------ ----------------------------------I----------•---- -------- ------------------------------------------------- -------------------------- ------------------------------ -----------•--------------------- <br /> Date -----------------------------------�� <br /> FINAL INSPECTION BY ----------------------------------- <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 10-52 Revised W-2100 <br />