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a� APPLICATION FOR SANITATION. PERMIT <br /> Permit No. __ �•-�-��( - <br /> (Complete in Duplicate) <br /> Date issued <br /> Zf �-1—I ;. - -. i <br /> Applica{ion is hereby made to the San Joaquin Local Health District for 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_ 0, 0 --Z ------- Q �---------------------- <br /> Owner's Name.C/A e / =° = _ _Phone <br /> .r <br /> Address _---------• ---- = ------------------ ------ <br /> ----------------- , <br /> ---------•4�-•- : S <br /> Contractor's Name- ` ��''�r _ `-' '�1f �Phone. ... r. <br />. Installation will serve: Residence M Apartment House ❑ Commercial ❑ ;frailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _J;___ Number of bedrooms _1_._:.yNumber cf baths _L_.-_ Lot'size ------__________________________________ <br /> Water Supply: Public:system'❑ Comm,nity system ❑ Privaf6,� ' Depth to Water Table 3W_ ft. <br /> Character of soil to a depth of 3 feeti Sand E] Gravel ❑ Sandy Loam ElClay Loam Clay E] Adobe E] Hardpan ❑ <br /> Previous Application Made: Yes ❑ No W i New Construction: Yes4 No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> r(No septic tank,or cesspool permitted if public sewer,..is.available,within 200 feet.) <br /> . <br /> -P *-: / <br /> Septic Tank: Distance from nearest well_ ____.___-___Distance fro fou ation______�_________.Material_____________________�____-,_______-_-.-_____fi <br /> No. of compartments----- -__ -- ----Size- +^ �---i4*--Liquid depth-- -----------------------Capacity---C -- i <br /> la <br /> Disposal Field: Distance from nearest well...��----:Distance from foundati n--F� _________:Distance to neares lot�line__�2_______-- <br /> g <br /> Number of,.lines-------- - - -- ----=---- -- Length of each line-----�2-Q-----3- -----.Width of trench-- ---------------------------- <br /> _-Depth of filter material___1> . _. -__-___Total length___.ftr_®_1___________________________ <br /> Type of filter materially-___ <br /> Seepage Pit: Distance to nearest well-....._______:_----_--Distance from foundation__---------_--------Distance to nearest lot line_-___-_________ <br /> Number of pits---------4------------Lining material--------------- •------Size: Diameter-----------------------.Depths----- :-_------------ <br /> i° Cesspool: Distance from.nearest well_______________r Distance from foundation.....,___-.___-.-_--Lining material------------___,______________--___ <br /> _-I*- --Liquid__Li uid Ca aci <br /> ❑ Size: Diameter--------------------------------------Depth --------------------------•----------------- o, p tY = gals. <br /> Privy:' Distance from nearest well--------------- ------i --------------_,;Distance from 'nearest building--:----------I--------------------------- <br /> - <br /> t. ❑ `Distance'to nearest lot line----------------------- ---•------------•------ ------------------------------------------ ---- -- <br /> --------- <br /> i -- -- -•------------ <br /> .Remodelin and/or repairing: describe '�" _� - _ -_ <br /> ------------------------------------------�---=---------------------------------------- <br /> -••-------•-------------• : <br /> --- -----------•--------------------------------------••-------------------`•-----------------------------•---•--------------------------- <br /> ------------------------- -----------=--------------------------------------------------------------- ------ <br /> I�hereby certify that I have prepared this application and.`.thaf the work will be done in accordance with San-Joaquin County <br /> ordinances, State laws; and rules and regulations oftheSan Joaquin Local Health District. l <br /> k i (J ____Owner and/or Contractor <br /> (signed}----a� - ----�----------- "� `t' <br /> r, (Title) <br /> T. I <br /> BY= - i+e) -s-=----------- <br /> _s2 <br /> I <br /> (Plotplan, 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--4_7/#_''1 - -----------------­----------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------ --_- - DATE <br /> BUILDING PERMIT ISSUED--------------• --------: --------- ------------------•-------------------= DATE----:----- -------------------------------------------------- <br /> ) -- --------------- <br /> Alterationsand/or.recommendations-------------------------------- - ••-------••-------_----------•-------.-----•----•---------------_--_-.-._----------------------- <br /> t ---------------------------•--•------ -----------------------9._.__ .. <br /> ---- -------------------------`--___ <br /> --------------------------------- <br /> ------------------ ----------'------ ---------------------'-----__. . <br /> • � .Lj ' <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, CaliforniaLodi, �California Manteca, California Tracy, California <br /> ES-9--2M ; Revised W-2100 <br />