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APPLICATION FC SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued --- <br /> Application is hereby made to the San Joaquin Loca! Health District for a permit to construct and install the work herein described. <br /> e'_ 4is application is made in compliance with County Ordina e No. 549. <br /> JOB ADDRESS AND �ATION-------9-W_ ------ - ------- <br /> j ?j------ ----- ------�;Z -_ - <br /> Owner's Na ------- ---- -- ...... .............. Phone <br /> --- - ------------------ --------------------- ---I----------------- -------------- ------- <br /> XJ <br /> opt <br /> Address ------- ------ - -------- ------------------- ------------------------------------------------- ---­-------------I.............. ----......­­-------- <br /> __4 * /X <br /> -- ------------------------------- ------------------------------------------------------- ---------- <br /> Contractor's Name--------- -_ --- ------ Phone ..= <br /> .......... <br /> Installation will serve: Residenceg Apartment House E] Commercial E] Trailer Court F] Motel Ej Other ❑ <br /> Number of living units: ---L Number of bedrooms 2.- Number of baths Lot size ----- ?iX--- --------------------- <br /> Wafer Supply: Public system xf Community system E] Private E] Depth to Water <br /> Character of soil to a depth of 3 feet: Sand [—] Gravel E] Sandy Loam El Clay Loam 11 Clay El AclobqZ Hardpan E] <br /> Previous Application Made: Yes E] Nox New Construction: YesX No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> tic ank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- <br /> .ep No. of compartments--------------------------Size-------------------------------Liquid depth-------------------_ Capacity-------- <br /> D --------------- <br /> � <br /> isr!sal'Feld:d Distance from nearest well___-__________--Distance from foundation--------------------Distance to nearest lot line----------------- <br /> of lines-----------------------------------Length of each line------------------------------Width of trench-------------------------------__-- �] <br /> Type <br /> rench------------------------------- <br /> Type of filter material-________________________Depth of filter material-----------------------Total length-_-----__---_----_--_-_.---------___---- <br /> o <br /> Seepa Pit: Distance to nearest welL,,-�__ _ ---Distance from gbndation--/e----------Distance to nearest lot line----?---------- <br /> Number of pits_____f_______________Lining material-, ee... <br /> Y ------ Size: Diamefer--_,V-- --- Depth..__.... --_----__------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.--__--__-__-----__._----------__ <br /> r-\ El <br /> Size: Diameter----------------------_--------------Depth----------------------------------------------------Liquid CapacitY----------------------------gals. <br /> rivy: Distance from nearest well---_ ---- ------------------------------Distance from nearest building--------------------------------- ------ <br /> El Distance to nearest lot line_ ----- ------------------------ ------------------I----------------------------------------------------------------- <br /> a _0_,- epairing (describe):-- <br /> Remodelin a ftrr 159 <br /> ------------ ---------------------------------------------------------------------------- ------------ --------- ----------- ------------------------------------------------------------ <br /> --------------- ---------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- <br /> .✓ . . ..... . <br /> .... ......... .... <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------ <br /> I hereby ce,4.;rfify" <br /> that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S+ e laws, ad des and r ulations. <br /> I of the San Joaquin Local Health District. <br /> _n.. <br /> (Signed) - -------------- -------------------------------------------------------------------------------- (Owner, and/or Contractor) <br /> By------------------ ----------4-1- ------------------------------------------------------------------------------------------(Titlej <br /> ----------------------- <br /> (Plot plan, showing si 0 of lot, location of system in relation to wells, buildings, etc., can be placed on ruse e)- <br /> FOR <br /> -FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------------- --------------------------------- DATE-------------------- <br /> _DATE----// ----------- <br /> REVIEWED BY-,------------------------------ ------------------------ - -- ---- ;e_;;-- --------------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------- --------- <br /> /W_t--------------------- - ---------------- DATE------------------------------------------------------------- <br /> Altera ions and/or recommendations: ------------------- -----------------------1-.___1e__ ------------------------------------------------------------- --------------------------------- <br /> ------------------------------------ ----------- <br /> ----------------------------------------------------/------ - --------------------------------- <br /> ----------- -/ -------- <br /> ---------------------------- -------- --------------- --------------------- ------------------------------------------------------------- -------------------------------------------------------- ----------------- <br /> ----------------------------------------------------------------------------------------------------- ----------- -------------------------------------------------------------------------------------- ------- <br /> INALINSPECTION 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, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M I0-52 Revised W-2100 <br />