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O APPLICATION FOR SANITATION PERMIT Permit No. ../- <br /> T.. .... <br /> ��"\ (Complete in Duplicate) / <br /> Date Issued _,AL/­"` <br /> _A..__L.�_ <br /> Applica+ion 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.......... -----•---------------------------------------------•....... <br /> Owner's Name.................. ----------------------------------------------------------------- --------.-. Phone..T! l•--3"4.379.. <br /> Address..............................AbOV A------------------------------------------------------------------------------------------------ <br /> Contractor's Name...-------------DELTA---INC. ------------------ Phone..Ho.....3-.1269.... <br /> --------------------------- <br /> Installation will serve: Residence >K] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ <br /> Number of living units: __1_. Number of bedrooms -_1_. Number f baths 1.... Lot size ...... <br /> ...................... <br /> Water Supply: Public system <br /> El system ❑ PrivateDepth to Water Table .!0-. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamU Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [?9 New Construction: Yes:F] 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-------------------------- __------_ _-------.Ex Ebt Ing No. of compartments------ -------------------Size................................Liquid depth-----------_---_--------Capacity----------------------- <br /> III Disposal Field:* Distance from nearest well-./e&t t-+-Distance from foundation-_-_r':;—--------Distance to nearest lot line..3_�......... <br /> Number of lines__________0-,- — - - <br /> Length of each line______..-8. .. .t ._....Width of trench �" <br /> ----- ---------- <br /> .� ' <br /> I Type of filter material--_�s�j _ f p Depth of filter materia-----t� __ --___--Total length........3_5.......................... <br /> Seepage P' . " Distance to nearest well t.�`------------Distance from foundation JIM10......Dist nce to nearest lot rrlipe_AMPIS <br /> ] Number of pits.._2.______._______Lining material__rQag.__..._..Size: Diameter___._.T �'_..___.Depth_..._.'fi_____________________ V <br /> Cesspool: Distance from nearest well-----------------Distance from foundation___:.--------------Lining material------------------------ <br /> .__-_--_____-. _ <br /> ❑ Size: Diameter----- --------------------------------Depth---------------------------------------------------Liquid Capacity--------...................gals. �• <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building.........................................., <br /> ❑ Distance to nearest lot line------ --_...-----•-------•----•--•------------------------------------•-------- •- --- ------ <br /> , <br /> Remodeling and/or repairing (describe):Ald ng .:1iwod(2-�- -.QPk-Pilled... .!kopAa _.pit!...In--- andem to <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) DEL`I'A...I i...------... "�c r --- ' 2__ ; (Owner and/or Contracfiorj. <br />` By: PMry_ W rthan---------------- ----------------------------------------- {Tile)_(den. Mir. <br /> (Plot plan, showing size of lot, location of system in-relation to wells, buildings, etc., can 6-04-66-3-66 reverse side). - <br /> FOR9P4RTM NT USE ONLY <br /> APPLICATION ACCEPTED BY----- - .; :. ..... -_.. DATE---- orf ------ ----------- <br /> REVIEWEDBY---------------------------------------------- -------------------------------------------------------------------------• DATE............................................................ <br /> BUILDING PERMIT ISSUED---------------------------------- ---_.. DATE............................................................. <br /> Alterations and/or recommendations---------------- ---------------------- ------- ----•-------•------------------------------------------•---------------...-•----•------------------------------- <br /> ----------------•--------------•------•---•--------------------------•------------------....------...-----------••-----•---•----------------------------------•--•-----------------------------•--------•---•---•-•----------. <br /> -----•---------------------------------------------------------------------------------•-----------------------------------------------•----•------------•--.._..---•--------------........................................ <br /> ----••-------------------------------------------------•----------------- -------------- ------ ---_..... ............. ------------------------ .............................................................. <br /> -------------------------------------------- -----------------•------_------------------------------------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:.._._.... ..�t Date-------------------- /'rl'f G! -------- <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 /> r--9 145446 ATWQDD <br />