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l ---------- � <br /> _AP_PLICATION FOR SANITATION PERMIT =N . O <br /> (Complete in Duplicate) y * _ <br /> Date Issued <br /> 4A,sp anion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND ATION___•___---SSI p-___._.__ <br /> Owner's Name. � <br /> ?�.O.. _a _- -------- - •---•_ --------------•---------------- --•--- <br /> Address---- -----•-------------------- -- - - ------- ---------- <br /> --------------- Phone--------------Contractor' -------s Name•_____ j - <br /> w -------------------------------------------------------------------------------------------------•---------------- <br /> --_-- _ <br /> --------------- Phone. <br /> Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court <br /> Number of living units: ___�__ Number of bedrooms ____,l.-Number of baths _--/- ❑ M/otel ❑ Other ❑ <br /> Water Supply: Public system [ Lot size ___-_-__6 �-._X_•_�Q <br /> PP y. -------•-------------- <br /> Y Community system ❑ Private ❑ Depth to Water Table ��ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[� Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 0 New Construction: Yes IV 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-_/Vo-7 Distance from foundation__"- ld- <br /> No. of compartments . - - - --------Materia___- <br /> --, <br /> p Size 'J Liquid depth.---C° Ca acit a`a _____ i <br /> Disposal Field: Distance from nearest weil__� Distance from foundation-__ - _ p y <br /> �9___.___-.Distance to:nearest lot line_,__-2-d,-�- <br /> DO Number of lines----- --_--�------- -------"----Length of each line------- '5---------;a----.width of firench__"-_� - _ -__"-- <br /> T e of filter material__���I S,/�. <br /> Type ________._____Depth of filter material-- length ----- <br /> --__----Total length.--_---•_-��- <br /> Seepage Pit: Distance to nearest well. �[�U NQ i ----------------- <br /> _--_.__ Distance from 6-_-_--.Distant to nearest lot line_.__ ___ <br /> I�] Number of pits--------- ---------- Lining material-- -0----[---t s9r�'CD ameter__--- '�` � <br /> Cesspool: -- ---------- Depth-----A;; �--- I <br /> P Distance from nearest well______________ ----------- <br /> Disfiance n---------------- Lining material--------------------- ' <br /> �--:-- - Size: Diameter------- ------- ------- - --------------- <br /> -----.----Depth---------------------------------- ---- ---------Liquid Capacity gals. I <br /> Privy: Distance from nearest well __..___.__--- _ <br /> Distance from nearest building-------- <br /> " <br /> ❑ Distance to nearest lot line---------------------- ----- - -- -------•-----"---. �. <br /> emodeling,and/or repairing (descr'rbe): -------------------------------------• . ------------------------------------- <br /> ---------------- <br /> --------- �. ! <br /> --------'c.�....�- <br /> --- ----- ------� --�-- - :----------- •----- _ ----- ------ <br /> .< i <br /> u ------------------ <br /> ---------------------------- ------------------ <br /> -- - -- prepared <br /> his a -application <br /> a -- ----------------------------------------------------------------------------•---- - <br /> I hereby certif hat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat aw , and rules and regul 'ons of the San Local Health District. <br /> (Signed)---------_____ --- <br /> --- <br /> -------------------- <br /> (Owner and/or Contractor) <br /> By: = <br /> ---- - r = t <br /> (Plot plan, s owing size of lot, location of system in relation to"wells, buildings, etc., can bel placed on reverse side---------------------------- <br /> FOR <br /> FOIL DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_____"-._______-- _"-- _-. <br /> ----------------------------------------------------------------------------------------------- <br /> DATE ...... ` <br /> BUILDING PERMIT ISSUED-------------- - DATE- - = <br /> --- - <br /> -------------------------------- ------ PATE----------- <br /> Alterations and/or recommendations:___________________ --`V----------4----------­--------------- <br /> �-------_____._______ <br /> --------- <br /> V <br /> --------- • --------•----.------ <br /> ----------------------- <br /> ------------------------"------------------ ----- <br /> -- -------••-------- <br /> FINAL INSPECTION ,BY:.."--_---"_-���-1 .:� -- <br /> - -------- ----------- z -s <br /> bate.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> 132 Sycamore Street 814 North "C" $tree} <br /> Stockton, California Lodi, California Manteca, California <br /> Tracy, California <br /> ES-9-2M ; Revised W-2100 <br />