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FOR OFFICE USE. _ <br />__ ______________________________. A ICATION FOR SANITATION PERMIT Permit No............... - <br />------------------ (Complete in Duplicate) u licate <br />" { ( P • ) Date Issued .....'.�l..�..� �.. <br />�!----------------------- --- This Permit Expires 1 Year From Date Issued <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. 549Air. <br />JOB ADDRESS AND LOCATIOf'!x._.. �'Gr----- <br />Owner's Name- "` =u'--•----------------------------------------------------------------------------------------------------- Phone ---------------•----•------- ----- <br />AddressJG------------------------------------------------------------------------------- <br />Contractor's Name-s:�----°�--- �----•--•--------------------------------------------------------------------------------------•--._'Phone............................ <br />Installation will serve: Residence [L'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel (] Other ❑ <br />Number of living units: __1---- Number of bedrooms .--Z--. Number of baths _1... Lot size ----------------------------------------- <br />Water Supply: Public system ❑ Community system ❑ Private EA—Depth to Water Table ±._S . ft. <br />Character of soil to a depth"`'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay []Adobe ❑ Hardpan ❑ <br />Previous Application Made -i f yes, date ----------- ,-------- ) No -New Construction: Yes Pg --No ❑ FHA/VA: Yes ❑ No C <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cilitippool permitted if public sewer is available within 200 feet.) <br />O� <br />Septic Tank: Distance from nearest well_-_..---. Distance From foundation_. ........... Material --- Irv_ _. _- - ...... <br />No. <br />[� No. of compartments --,.2 - ----------------- Size..XK. _C_3 g`__- Liquid de th..2�-R--------------Capacity..r- ...... Disposal Field: Distance from nearest well:S----------- Distance from foundation...3.6-- ........... Distance to nearest lot line-!3� i <br />............. <br />®-- Number of lines _--.•---_---_!-------------------- Length of each line ------- 7 t `..-_----.--....Width of trench ----- -2-Y a._-_--.----_--___--- <br />Type. of filter material �� �'�------------- Depth of filter material._: 1'! ----------- Total length_-_-.-- � ....._-_..._....__.._ <br />Seepage Pit: Distance to nearest well �Qo_--_ -----___Distance from foundation._. 44 -•__.Distance to nearest lot line ................. <br />Number of pits ------- /------------- Lining material�r..0A---_--.Size: Diameter ......... 3-.3....... Depth ----------- 2.43..------------ <br />Cesspool: Distance from nearest well ---------------•- Distance from foundation -------------------- Lining material .............................. ;...... <br />. <br />❑ - Size: Diameter-------------------------------------- Depth -------------------------------------------------. Liquid Capacity ------ . -- <br />Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building..... _----------------_---------- <br />Distance <br />---_ _,----- -------.-.Distance to nearest lot line ----------------------------------------------------------------------- -........................................................ ._..---------- <br />Remodelingan4&r repairing (describe): ------------------------------------------------------------------------------------------------ ........................................................ <br />ii <br />..........................t .. •-----------------•------....-•---------------------•-----•---•------•-------------------•-----•---•------•- •----•------------------•----- <br />--------------------------------------------------------•-•--------•-----•---•-------------------------------------------•- --------------------------•-------...--•-----------------•--•-•-•----.......---•--•-------- <br />-----------•---•------------ ---------------------------------------------------------------------------------•-------------------------------------------------------------------•----------------------------------- <br />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 laws, and rules and regulations of the San Joaquin Local Health District. <br />(Signed)------------------------------------ -- -- ------ ---------------------------------------(Owner and/or Contractor] <br />g • (Title)_ <br />y ------ ---- --- <br />(Plot plan, showing , locatio of system in relation to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT VSE ONLY <br />APPLICATION ,ACCEPTED BY---- 'eG"-- ------------------------------------- DATE ------c . �5 o --- ---------------- <br />REVIEWEDBY --­------------------- ----- - --- ---------------••-------•-•-•------•-• DATE- .............................. <br />BUILDINGPERMIT ISSUED .............................................................. _...................................... DATE .................................. <br />Alterationsand/or recommendations: --------------------------------------------------------------------------------------------------------------- ------------------•--------•----------------- <br />---------------------------- I ........................................... ............................................................................. <br />---------------------------------------------------•----•-------•-------•-------.....---------------------------•--•-----------------------------•-----•...-------•---•--------------•---------------•------------------------------•• <br />--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br />--------------------------------------- ­ ....... ............................................................................................................................................................................ <br />----------------------------------------- ------------ .......... I --- -..--------- - --= --------------------------.....------------------------•------------------------------------.-......------------------------------- <br />FINAL INSPECTION BY:....------ ----- -- -------------------- Date.--- X;2.._.... .... ------ .......................... <br />7. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street <br />Stockton, California Lodi, California <br />ES -9 REVI6ED 8-59 F.P.CD. 2M 6.60 <br />124 Sycamore Street 205 West 9th Street <br />Manteca, California Tracy, California <br />