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'3 APPLICATION FOR SANITATION PERMIT Permit No. .40....7_4 <br /> I O (Complete in Duplicate) <br /> b N Date Issued - 13 <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--------S-�_ ' <br /> -- ---------- --------------------- -- - -- - -------------------------------------------------------------------------- <br /> Owner's Name....................................... ~ ----- Phone------------------------------------ <br /> Address-------------------------------� l _. ------- -�-- •---- ------------------------------------------------------ <br /> Contractor's Name-------- .�"�tJ._--. �_ .. __ ......_ _. MK °1... t�vt,� Phone.�(_�.4?.. .•. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1----- Number of bedrooms-. Number of baths ---L.. Lot size -------6--t2_, ":_f.._.13—A__-__--__-__--_ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ,*4 ft. <br /> Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ ay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No e New Construction: Yes 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_________________Distance from foundation--------------------Material------------------------------------- <br /> --- <br /> _._____.. <br /> ❑ o. of compartments------------- ------- ----Size................................Liquid depth-------------- -----------Capacity---------- ---- <br /> Disposal Fiel Distance from nearest well lQ----.-Distance from foundation..J.-�--___-_.Distance to nearest lot line.-,/.10___-.N <br /> Number of lines__._�"Y' ,__ Length of each line____. L>!_____ Width of trench------ <br /> ❑ g - p • <br /> Type of filter materials___ __ Depth of filter material__..- __ Total length-----------14-10-------------------- <br /> Seepag <br /> _ 10--____________---_-- <br /> Seepage Pi Distance to nearest well__1.44---------Distance from fou ation_.f.a3+ ..Distance to nearest lot line._*5 O. .__ <br /> ❑ Number of pits__-___Lining material.. _ « Size: Diameter----- .� <br /> ��'�� <br /> Cesspool: Distance from nearest well_________________Distance from fou ndation--------------------Lining,material__----__---._____-__---.--.-_--___-__. <br /> ❑ Size: Diameter---------------------------------- ---Depth-----------•-------------- ------Liquid Capacity-------------------•-------gals. <br /> Privy: Distance from nearest well___-------_--------------------------------------Distance from nearest building-------------------.-_.-_-____--_--_---_- <br /> ❑ Distance to nearest lot line----------------------------------- ------- ----------------- ---•-------------------•----------- <br /> Remodeling and/or repairing (describe)--------------------------- ----- ---------- <br /> ----------------•---------------•------------------------- +�---------- _----ri4llbe <br /> --- --• ---------------------------•--•-------••---------------------- <br /> -------•-----•-------------------------------------------------------------!-- --------------- <br /> --- - - <br /> -------------------•--• ------•------------------------------------------------------------------------.......................... ----•---..... ......---•••••------ -------------------------------------- <br /> I hereby certify that I have prepared this application and that the workdone in accordance with San Joaquin County <br /> ordinances, State law , anrules and re tions of the San Joaquin ocal Health Distri <br /> (Signed) -Q � '��? O d/or C tractor] <br /> BY: = -- .. - -------- ----- (Title) <br /> e- ,A <br /> -- ---------- . ---- <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--------------------- ------- ------------------------------------------------- DATE--------------- ..�-..t ��S'Z,------------- <br /> REVIEWEDBY---------------------------------------------------------- DATE------..................................................... <br /> BUILDINGPERMIT ISSUED--------------------------------- ------ --•-•------•------••-----•---------------------------_..... DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:............................................................................................................................................................... <br /> ---------------------------------- --------------------------------------------------------------------------------------------------•---------------------------------------------------------------------..----------- <br /> --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------•------------------------------------------------------------ ---------------------------- --------------------------------------------------•-- ••-•---- <br /> ----------------------------------------- ------------------------­--- ---------------------------------------------------------------••------ ----- ------ - ------- ----------------- <br /> h <br /> FINAL INSPECTION BY:.. Date y -- ------•--- f--------- ----------------- V <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 I0-52 Revised W-2100 <br />