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lw- <br /> APP.LIOATION 'FOR SANITATION`PERMIT. Permit No. .3 <br /> (Complete in Duplicate) <br /> r - Date Issued ---' <br /> Applica+ion is hereby made to the San Joaquin Local Health Districrfo a permit to construct and install the work herein described <br /> This application is made in compliance with County Or ante No. 549. <br /> JOB ADDRESS AND LOCATION:_ ' z« <br /> :----------------------- <br /> _ - -g--- <br /> Owner s Name---.. _ .. '`Ph <br /> on _- -.M- <br /> Address----, -._ --=-t---- - i j i. <br /> b <br /> _-••----------------------------•-__•---.•-------------_--_--__----...-_••_----- •-- __- -... <br /> Contractor's Name--__- _ ---. ' <br /> - - <br /> - ---------------•------ -- ---------•----------------------- Phone <br /> F f <br /> Phone--------•-Installation will serve: Residence g------------•---------- <br /> e artment Housmercial ❑ Trailer Court ❑ Mptel [] Othek I] <br /> 9 f 1 <br /> Number of living units: ._-. -._ Number of bedrooms ? Number baths _ <br /> Lot size --R 'r x:1r ___ -------- <br /> Water Supply: Public system ❑ Communitysystem E <br /> Y ❑ Private Depth to Water Table _-.-.-__ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑r�Sandy Loam,P Clay Loam E] Clay E] Adobe Hardpan [] <br /> Previous Application Made: Yes [❑ No [ 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----._ 1 <br /> No, of compartments-_---__ <br /> --Material -= == '- <br />' --------- rSize? Liquid dept :-CapacitY <br /> Disposal Fi Distance from nearest wel --- prance from foundatio <br /> ----•. <br /> Distance to nearest lot lin <br /> r� r <br /> Number of lines_---___-_-_ /_:•__ __ Len th of each line__-. _-_ .� �_ f <br /> 9 C5_d Width of trench . -- <br /> Length <br /> �- ---------------- W <br /> Type of fitter materi tT---. <br /> t Depth of filter -------- <br /> Seepagematerial r!-- -- .----Total length__-____. - <br /> Pit: Distance to nearest well-_ _-.--__---,Distance from foundation-------------------- <br /> :. i ,- .Distance to nearest lot line________________• .J <br />'A '` ❑ - Number of pits----------------------Lining material------------------------Size: Diameter-'-----___--- <br /> ---------.Depth,--,---------------------- - <br /> esspool, Distance fr m nearest well---------------Distance from foundation---------------------Lining material-_ <br /> ❑ 5i7e: Dram ter-------------------------- ------Depth-------------- <br /> Liquid Capacity-------.-------------- gals <br /> f <br /> Privy: Distance from nearest well-----.___--..________._ ___-__---._bistah,ce from nearest building --=------•---------- - C <br /> 1 <br /> ❑ Distance to nearest lot line----------------------------------------- .. � �� p <br /> Remodeling and/or r-epairing�(describe}________ __.___ 1 + <br /> 1 ------------------------•---= <br /> t -_. <br /> ----------------------------------------• - <br /> ---------:------------------------------------•-------------••---•---•----•--------------------------------------------------------- ------•--••--•-----------------•-----•--------------•------ ------------ <br /> -----------------------------------------------------------------------------------------------------------------------•------•----•-----------------------------=-----------•----------------------------•------------- <br /> I hereby certify that I hav prepared this application and Apt the work will be done in accordance with'San Joaquin 'County=.... <br />{ ordinances, State laws, nd r es and r tions of the San J r�Local Health District. <br /> rt f <br />"' . <br /> (Signed), ...... <br /> ----------------------------------•----------------------------------{Owner and/or Contractor) <br /> By:--------••--•............. Tale <br /> ------ _ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> a <br /> APPLICATION ACCEPTED BY-- DATE _ 1 <br /> REVIEWEDBY------ --------------------- -- - ��-...---.-.._..------------------------------------- <br /> DATE-_ _.__.- <br /> BUILDING PERMIT ISSUED----- � ---------------------- <br />�.. -------------------------------- DATES { <br /> Alterations and/or recommendations-------------------- .- <br /> -----•-----•----------------------•----- - <br /> -------•-------------------------- <br /> ---------------------------------­----------- <br /> ---------------------- <br /> FINALINSPECTIO'Nf BY--------------------------- '' � /� <br /> -------------- ---- Date <br /> ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street <br /> 814 North "C" Street_� <br /> Stockton, California Lodi, California Manteca, California <br /> Treey, California <br /> ES---9-2M Revised W-2 1o0 f <br />