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. <br /> APPLICATION FOR SANITATION PERMIT 5 Permit No. .....� -r...__.. <br /> (Complete in Duplicate) <br /> Date Issued -------- - <br /> s-S" <br /> Applica+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 /> y'. <br /> JOB ADDRESS AND L,O TION-- --------• SQ•--- -- ----- -- <br /> Owner's Name--XV ­­-------- -- Phone.................................... <br /> Address_...®-"� .�! - --------, - -------- ----- <br /> - ---•- <br /> Contractor's Name --•- ^`� ------- ------------- Phone <br /> Installation will serve: Residence 41-Apartment HouseCommercial ❑ Trailer Court-❑ Motel ❑ Other <br /> Number of living units: _f____,Number of bedrooms__`Number of baths J-__- Lot size ....... _............ <br /> Water Supply: Public system,, Community system ❑" Private ❑ Depth to Water Tables-0 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: Yes ❑ No 4.New Construction: Yes 4-0617— <br /> TYPE <br /> -06 ffTYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> t - <br /> Septic Tank: Distance from nearest well ___ Distance from fopndation___-1�--------Ma erigl.... r0`Y__________ ______.__.. <br /> ..--- No. of compartments--------_2-:--------_-Size._1.4 .._I�.. .Id_.---Liquid depth_(/_ ----_______:Capacity...JrA.#�..... <br /> Disposal Field: Distance from nearest well _Distance from foundation..../ZDistance to nearest lot line Z.0-..... <br /> �- Number of lines...........1 s� _ _ Length of each line...... ..J......Width of trench__..i _ �.'_ _____________ <br /> Type of filter material____ r_____�.f_s_9Depth of filter material...._ ,�.___-__Total length......fi.0..._______________________ <br /> Seepage Pit: Distance to nearest well -. __Distance m fou ation.._.. 4Q___.. <br /> ' Qd , b��_�-.Distan to nearest lot line r <br /> AHumber of pits_. --I-_._-_- -_-Lining material... M !!kS_ ize: Diameter____- -____Depth___J,_r,�------------ ------- <br /> Cesspool: Distance from nearest well________________Distance from foundation-------- . Lining material-------------------------------------- <br /> 0 <br /> _ ___.-.-❑ Size: Diameter--------------------------------------Depth--------- ------------------------------------------Liquid Capacity- - ---------gals. <br /> Privy: Distance from nearest well-________ ____-------------------------------- Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line-------- -- ----- ------ ---------------------------------------------------------- ---------- <br /> Remodeling <br /> - -----Remodeling and/or repairing (describe):--------------.............................................................................. ..... <br /> ------------•----------------------------------------------------------------------------------------------•-• 1 ----- <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)... -- ......... . . --- •-- -•-•----------- . . .....•...�1!C..l /! ...- F(OwrA Contractor) <br /> ------- <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 /> APPLICATION ACCEPTED BY-------- ---------- ----_---------------- DATEi ----------- .....�_ ...... <br /> (/•_9 <br /> REVIEWEDBY -----------•----------------------------------­--- DATE............................................................ <br /> BUILDINGPERMIT ISSUED.............----------------------------••-------------------------------------------------------... DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:........................ ------------------•---------------------------------....------.......--------------....-_.....---•--------••----•=------...------.... <br /> -••---•-•--......................-••-----------•••---•----•-••----•----------------------••-------------------------•----•---------------•---......--........................................ ........................ <br /> ---------------------------------------------••---------------•---------------------------------------------------------------------------------•..-------------------------•-••--•---------------------------••-•----------•- <br /> ----------------------•--------- ------------------------------------•-••••---._...---._.....•-••-•-•-••-•-••...-----•-----------------------•----•••-------------------••------------------------.....---••-......---••- <br /> /`� ��' <br /> FINAL INSPECTION BY:. 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 Revised W-2100 <br />