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ti Y <br /> APPLICATION FOR SANITATION PERMIT Permit No, <br /> R (Complete in Duplicate) / <br /> Date issued .--- <br /> Applica�ion is hereby made to the San oaquin Local Health District for a permit t nstrucf and install the work herein described. k <br /> This application-is made in compliance wi b?CoLrnty Ordifiance No. 549. <br /> JOB ADDRESS 6V5 LOCATI <br /> Owner's NaQe--- - ------ ----- - �--�FJ : ( ct j --Zl�e7� p <br /> ----------------- -----------------•---- <br /> ne <br /> Address---- <br /> Contractor's Name--- - ------ ------- -------------- #t <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Others❑ <br /> ' Number of living units: ---- Number of bedrooms :-Z- Number of baths -:'-_.,Lot size`_- -- _0 _ ...................... <br /> ater Supply: Public;system '0 Communitj i�stem- —Private" <br /> Y Y ❑ ❑' "Depth t" titer Table :-- -- ft. <br /> I ! ' <br /> Character of soil to a depth of 3 feet: San Gravel ❑ Sandy Loam <br /> I Clay Loam El"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 pubic sewer is?available within 200 feet.)t 4 d <br /> Septic ank: Distance from nearest wef# �5 ante fro foun ton_-�. -----------Materi�I <br /> No. of compartme's------------- ` - =$ize -- kC }Liquid eptly-----__- ----------Ca acit -- <br /> Dispos Field: Distance from nearest w 1-___Q---_-~.-.Distance from,fouridation.`�.__-_._ Distance to nearest lot line- -__ <br /> Number of lines..... ... . .:..�__ Length of each line----------- <br /> Width of trench.-----._ - <br /> Type of filter materi . .-- i r`------------- <br /> V4 <br /> ------------ 4 <br /> Llepth of filter material---_.-__� -- - -___-Total length-------- -- - _ -- <br /> Seepage Pit: Distance to nearest well-.------___----.-----Distance from foundation-------------J------Distance to nearest lot line------.--_-_---.- <br /> ❑ Number of pits------ --------------Lining material------.----------------Size: Diameter------------------------ <br /> depth- --------------------•-----•---- <br /> Cesspool: Distance from-nea.Eest well-----------------Distance from,foundation-z-----_---- Lining.,material-.---'; :`---:_�-------— <br />�Jm M .__s;__ --------------------------------:----Liquid Capacity --------------------------gals. <br /> -Size: Diameter--:_-- ' -.. - '."•� v �' E Privy: Distance from nearest well---------------------- _ <br /> ----------- _-__-----:---Distance from nearest buildin <br /> ❑ Distance to nearestlot"line"`"__-:` I g - <br /> Jelin and/or re�aiin escribeJ' ----�- ------- ---- =- ------------•---- --=----------- ------------ - -------- <br /> ------------- = <br /> --------•----------------•---------------------------- <br /> } ry--------• --------------- ------------•-----------------------•------- <br /> - u r <br /> - <br /> ---- •------ ----- ----- - ---- -- -• ---- `-- ----------- ------ ----- •----- ---- ------ --- - - ---- <br /> I hereby certify that I have prepared this application and fhat,the work will be done in accordance with San Joaquin County- <br /> ordinances, St to h ws, and rule and re ulations of the San Joaquin Local Health District. <br /> [Signed}------------ - -- -- ± � -q <br /> • <br /> ------ -�Owner <br /> d/or Contractor} <br /> By:..........-----------y- --------------------------------------------- <br /> j <br /> s <br /> -� --------=---------------------------------- Title <br /> ( " } :--------£-------------------- ------------------ <br /> [Plot plan, showing size of lot, to ation of system in relation to wells, buildings,-etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY. <br /> APPLICATION ACCEPTED BY ------- -- --- ----------------------------•---t-- ------------ ------------------------- DATE <br /> REVIEWEDBY --- --- ------ -------- -----------------------------;------------------------ - ---------- DATE--- <br /> - <br /> BUILDING PERMIT ISSUED-------------- f <br /> --- - <br /> _ ---------------------- = DATE <br /> ---------- <br /> Alterations and/or recommendations:--------------------------------------- =_ <br /> ---•---------=-----------=---------------•----•----------_1 <br /> ---------------•-----------•-----•-- =------ i <br /> ---- ----------------------- <br /> ----------- <br /> FINAL INSPECTION BY:_ - _ -a <br /> 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 /> E <br /> ES-9-2M Revised W-2100 <br />