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FOR OFFICE USE: <br /> -------------------=-------------------------------- ---- <br /> - ---------------------------------------- APPLIC&PON FOR SANITATION PERMIT„/ ---rmit Ne ... <br /> rm <br /> (Complete in Duplicate <br /> ------------------------------- ----------- ---- ---------- This Permit Expires I Year From Date Issued Dafb I-ssued ---- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constructand 'install the w. rk herein"described. <br /> This application is.. made in compliance with County Ordinance No. 549. <br /> ;V , <br /> JOB ADDRESS AND LOCATION 41�j.t'--v /'a <br /> --------- ­ qefl/ 02Z O-- 2-C. <br /> ----------------- <br /> Owner's Name........... -------------------------------------------- <br /> Address................I"";I ..0. 2 2— V I------------------------------------------------------- ----------- Phone.. <br /> -.7------- -W/ <br /> 4�------I-----Re------------­-------P/_V. <br /> ------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name------ -- ------------------------------------------------------------------------ ------------------------------------- ------- Phone----.--.-------------------------- <br /> Installation will serve: Residence E] Apartment House E] Commercial 0 Trailer Court E] Motel [I Other F] <br /> Number of living units: -------- Number of bedrooms -------- Number" of baths J______ Lot size A�__ ------------------------------------------------- <br /> Wafer Supply: Public:system [I Community system E] Private E] Depth to Water Table 110--- ft. <br /> Character of soil io a depth of 3 feet: Sand [-] Gravel [-] Sandy Loam EM Clay Loam El Clay ❑ Adobe E] Hardpan E] <br /> Previous Application Made: (If yes,date-------------------- No,E New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF.INSTALLATION AND SPECIFICATIONS: <br /> -�(No septic:�tank or cesspool permitted if public-sewer is available within 200 feet.) ot <br /> Septic Tank: e 17 !t----Distance from foundation--- <br /> Distance from nearest well-w -------- ateria ------- -------- <br /> aNo. of compartmenfs_2;!L--- -------------- ------------Liquid clep�h......./------_--------Capaci'tyi�070-------------- <br /> Dispc_sai Field; Distance from nearest welW .._.___Distance from foundation-_-�19............Distance to nearest lot lin i eA_ <br /> Number of lines-----.1----------------`-----------Length of each line---90----------------------Width of trench----a ---------------- <br /> Type of filter maferia+,r.,- <br /> j? <br /> Depth of.filter material____1 ----- <br /> f/ --------Total length__ _'________________________-------- <br /> Seepage Pit: Distance to nearest well____'__________--____Distance from foundation--------------------Distance to nearest lot line_______________ <br /> k <br /> 171 Number of pits----------------------Lining. �natarial---------- ------------Size: Diameter-----------------------Depth---------------------------------- <br /> Cesspool. Distance from nearest weil_: -- <br /> ---------- ----Distance from foundation___________________Lining Lining material--- ------- -- <br /> --- -------------------- <br /> ❑ <br /> Size: Diameter--------------------------------- 3.- Depth----------------------------------------------------Liquid Capacity----------------------------gal i <br /> Privy. Distance from nearest well--------------- __________________._Distance from nearest building <br /> ----------- ------------------------------------------ <br /> ❑ Distance to nearest lot line,__ I <br /> Remodeling and/or repairing (describe):-----:-----------111�-L------------------------------------------------------------------------ -------------------------------------------------------- <br /> ----------7------------------:------------------------------------------------- ---------------------------------*--------------------------------------------------------------------------------------------------------- - <br /> -------------------•-------.----------•_---------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- <br /> ----------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------­--- ---- <br /> I hereby-certify that I have repared this application and that the work will be done in accordance with San Joaquin County <br /> as, S�ffe laws, P,' eg a ions of the San Joaquin Local Health District. <br /> ordinances, and ruts e . I t* <br /> - -------- -- ----- - -- --- -- ------ ------------------------------------------------------------------------- ------------------------(Owner and/or Contractor) <br /> By:---------------__ _- -2---------------- - ------------ <br /> --------- ----------------------------------------------- -------------(Title}------------------- ----------- --------------------- <br /> (Plot plan, showing size of lot,.Iocation of system in relation to-wells, buildings, etc., can be placed- on reverse -side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__A,4_�_ ----------- ------------------ ---------------------------------------- DATE___/__- <br /> ------------------------------------- <br /> REVIEWEDBY-------------------------------- --------------------------------- -------- - ------------------------------------------ DATE------------------------- <br /> 'U'LD'rNG PERMIT ISSUED---------------------------------- -------------------------------------------------------------------- DATE <br /> Alterations and/or recommendations:----------- <br /> ------------------------- --I-------------------------------------------------I--------------------------------------------------------------------- <br /> --------------------------------------------------­--------------------------- ----------------------------------------------------*--------------------------------------------------------------I-----------I------------ <br /> ----------------------------------__-------- ------- --­---------------------------------I---------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------- ----------------------------- ------- --------------- ----------------------------------r----------- -------------------------------------------------------- ----------------- <br /> --------------- --- ------------------------------------------------- ----------------------------------- -----------I----------------------------------------- - ----------------------------------------------------- <br /> FINAL INSPECTION BY:--- ----------------- Date...�� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California mfr Manteca,California Tracy,California <br /> ES 9 REVISED B-59 311A 3-'63 F.F.C10, <br />