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p ` APPLICATION FOR -ANITATION PERMIT Permit No. --- <br /> v (Complete in Duplicate) y.� r�Q <br /> Date Issued ._..__,_�t_..1. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta w r i scribed. <br /> This application is made in compliance with County Ordinance No. 549. &Akyj& <br /> JOBADDRESS AND LOCATION-----------------1818-- Se _ pB M St.--------------------------------------------------------------------------------------------------- <br /> Owner's Name L��__.Alld._R 4 i'�Q __3Lt111Ve11------------------------------------------- Phone H�= 8~'7 39 <br /> Address--------------------1$18...5.-- .H-"---_5t.-i------------ --------------------------------------------------------------------------------------------- ---------------------------------- <br /> Contractor's Name----- Tank Berv. , Inc. Phone____Ho. 3'"'7727 <br /> ---------- --- --------------------------------------------------------------- --•- <br /> Installation will serve: Residence [jt Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ -.._ Number of bedrooms --2--- Number of baths ---!-- Lot size -----95 x360 <br /> Water Supply: Public system [ Community system ❑ Private ❑ Depth to Water Table A.5_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [)L Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ® New Construction: Yes 9 No ❑ FHA/VA: Yes ❑ No 14 <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 /> aisting No. of compartments-------------------------Size--------------------------------Liquid depth.-------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line•__._---_-___-__- <br /> Tisting Number of lines---------------.-------------------Length of each line---------- -------------------Width of trench---_---____.___---------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ <br /> \Seepage Pit: Distance to nearest well------1'1Q----------Distance from foundation___.-!ot__..___.Distance to nearest lot I'ne_ e_______________ <br /> [X Number of pits------1-------------Lining material __--r_QCk------Size: Diameter--_--.33n._ 2 Xe <br /> ------Depth--------��-- -----MBI---------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_--___--_--___-_---_-_-___-_---__-___ <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. �l <br /> Privy: Distance from nearest well----------------------------------------------- from nearest building-_--_-___--------.----.______--.---_.__-. <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------ <br /> Remodeling and/or repairing (d'escribe):---------adding_... eeppge-__pi----------------------------------------------------------------------------------------------- <br /> t t0 existing system <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 /> By:------------P.erry---Warth --------------(Title)----f en.-Mgr`---------------------------------- <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 /> 3 <br /> APPLICATIONACCEPTED BY--------- --- ==----------------------------------------------------------------------- DATE-------�� �� '... ...•r_"------------------- <br /> REVIEWED BY---------------------------------------------------------------------------------------------------------------------------- DATE.------------------------------------- <br /> ------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------- <br /> ------------------------------- t_ ---- - ----:Q- -•---. �' <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------------------- ------- -- - ------------------------ ------------------------------------------------------------------------------------ <br /> ---------------------- - <br /> FINAL INSPECTION BY:------------- ---I ------------------------- Date----------- /y f <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 1-57 FY.CO. <br />