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1 qc] <br /> APPLICATION FOR SANITATION PERMIT Permit No. .-�_�1_. __.__._ <br /> (Complete in Duplicate) <br /> . Date Issued <br /> Applica+ion is hereby made tolthe'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 /> u JOB ADDRESS AN GATI'ON Zv�U '/' --------t1. ¢'�'�✓ '�'- .�� ?"`�_- w-- <br /> Owner's Name = IJ Yl = l Y = Phone. _ _ .._._... <br /> Address </t ° ' -y `�-�---------------•. ---•---•....I..._... f...._.. , <br /> Contractor's Name.--A it fl ,1.-­ ---.�1✓C---------------------------- ------------------------------�- ----- PhoneJ-4.... <br /> Installation will serve: ;Reside nceApartment House [I. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 <br /> Number of living units: ,L_,�__- Number of bedroomsNumber of baths __ ___ Lot 1t1size -_/ _G_f---------------------- "3 <br /> Water Supply: Public'system ��"Community system [I' Private ❑ Depth to Water Tiable c° ft_ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej---Hardpan ❑ . <br /> 3 <br /> Previous Application Made: Yes ❑ No New Construction: Yes �No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t t <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! <br /> _ ..., _.�, .. <br /> Septic Tank: Distance from nearest weIl11Ut_e__:Distance from foundation---/_6_----------material___ _______________ ` <br /> No. of compartments--------- -------..----Size_ _ `�_ �--- Liquid depth--�, _`_` ---.----- Capacity---jGO GSL_ <br /> Disposal Field: Distance from nearest wellDistance from fcundation__v_t ---------Distance to nearest lot line__,. /_-____. <br /> y ❑� Number of lines------------f.1__*C----_`-----Length of each line---------6-----i(__._.Width of trench—fir/._'................... <br /> Type or filter material---I/i. --_5;----9%De th.of flter material--j_1- --r -.Total length <br /> --- __;____________________ <br /> ________ <br /> Seepage <br /> Pit: Distance to nearest.well___210N4F__Distance from foundation_...1__._____---.Distance to nearesf`lot line_­_-�--------- <br /> Number of pits---f�4/-E_---'---Lining matenal__AC/f _--•- <br /> -�_--.-Size:'Diameter--.- -9-----------.Depth-----`�` � <br /> - - ------ ----____-- <br /> 11 <br /> Cesspool: Distance from nearest.well-----------------Distance'from foundation..-._________.___.Lining material---.________-___--___--____.___. <br /> 0 Size: Diameter ------------- --------- Qepth =_ -= t; Liquid Capacity gals. <br /> Privy: Distance 'Horn nearest well------__----____ _______________ ______ Distance from .nearest building_______.__._______________..____----. <br /> ❑ ..,.., Distance to nearest!lot-line.------ = '- "-------- --------------------------------------------------x ---------- ------ <br /> Remodeling and/or repairing (describe}: c?--� i .G........................................� .. `------'-•------------------------------------------------ �� <br /> 5 <br /> _______________________________________________________________________________________________________________________________________________________________�_________________-_--_______________________-_____________.__ <br /> 1 <br /> ,,t. <br /> -..--.._________________________________ _____________________________________________________________________________________________________________________ _________ <br /> I'Ihereby,cerfify 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 /> i <br /> (Signed) �C p-----------------------/--i S/� -------------- _ -_ -- %Owner and/or Contractor <br /> ( g ) j <br /> li --. �,�� � ---------------------(Title}--_ --r------------------------ ---------------- <br /> (Plot <br /> ---- ---- <br /> i <br /> (Plot plan, showing size of lotjocation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> a FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ------------------ -------------- DATE----- ------------------------------------------ <br /> REVIEWED BY _ ----- ---- DATE <br /> --------PERMIT ISSUED ------------- <br /> Alterations <br /> `- ------------------------ DATE �� - -- ---- - <br /> Alterations and/or recommendations:--------------------- ___ ____ r ------------------------- <br /> ------------- <br /> -------- <br /> > # <br /> -------- ---------------------------------------,--------------- ------------------------ ----------------------_----------------;---------........--------- <br /> ---------------------------------------------------= --------------------------------------------------------------------- ------------------------------------1-1---------------------------------- <br /> ------------------------ <br /> 1 I <br /> 4 <br /> ��y I . - <br /> FINAL-INSPECTION'BY:- `" ----- --------------" " _ _ Date-.. '_.A-C�_ <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 W-2100 _ } <br />