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APPLICATJO1 CFOR SANITATIC Permit <br /> 7 <br /> (Complete in Duplicate) Date lssuecl� <br /> Irl 1 P lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.T application is made in compliance with County Ord inanee No. 549. <br /> JOBADDRESS LOC Y.PN--- A- -----I— I------------ ------- I----- - --------------------------------------------------------------------------------------------- <br /> Owner's Name__ -------------- --------- ------------------------------------- ------------------------------------------ Phone---------—--------- <br /> Address---c3---`_l--Q--_ <br /> --------Address___c3----- ---g__ <br /> Contractor's Name--- -- ---- -- ---------- --------------------------------------------------------------------------------------------------------------- Phone- --------------------------------- <br /> Installation <br /> hone----------------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial Ej Trailer Court E] Motel [] Other <br /> Number of living units: _--I___ Number of bedrooms ----L Number of baths ___I___ Lot size ____/_Oc:E--- ----------------- <br /> Wafer Supply: Public system [Community system -E] Private E] Depth to Water Table -------- ff. <br /> Character of soil to a depth of 3 fee Sand E] Gravel E] Sandy Loam F__J—Clay Loam E] Clay Ej Adobe Ejg�Hadpan Ej <br /> Previous Application Made: Yes ��No 0 New Construction: Yes No n <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public,yewer is available within 200 feet <br /> Se ank: Distance from nearest well J_9__'7rD'sta K from f Material--- <br /> �C?uncl <br /> No. of compartments---------- ; x J1 - -d d ---------------------- pacify---'- <br /> P Si,9- _/_ Ki----------- <br /> ------------ ----------- q <br /> Dis Field: Distance from nearest w 11 Distance from foundation /U -Distance to nearest lot li e <br /> t( ----- <br /> 71 Number of lines____________ f-------Length of each line----------- ---.Width of trench------------ <br /> Type of filter maters pth of filter material--------/ ---------Total length--- ------Z-0-0------------------ <br /> Seepage Pit; Distance to nearest well----------------------Distance from founclation--------------------Distance to nearest lot line__--__-_--___-___ 06 <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depfk--------------------------------- <br /> Cesspool: Distance from-nearest well-.----------------Distance from foundation---------- ---------Lining material__________________-________________- <br /> LA' <br /> El Size: Diameter------------ - ----------------Depth----------------------------------------------------Liqu;d Capacity----------------------------gals. <br /> Privy: Distance from nearest well________________________________--- ----________Distance from nearest building-.-------- ------------------------------- <br /> n Distance to nearest lot line----- <br /> Remodelingand/or repairing [describe):---------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - -------------------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------I----------------------------------------------------------------------------------------------------------------------------------------------------------------- <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 e San Joaquin Local Health District. <br /> (Signed)--- --- ------------•-----------------------------------•----------------------------------{Owner and/or Contractor} <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title}--------------- ---------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_(_ --------------------------------------------------------------------------------------------- DATE <br /> � ----------------------------------------------- <br /> REVIEWED BY------------------- <br /> ------ ------------------------------------------------------------------------------ DATE------ - ------------------------------------------------- <br /> BUILDING PERMIT ISSUED---- -- ---------------------------------------------------------------------------- DATE---------- ---------------------------------------------- <br /> Alterations and/or recommen - ----------- <br /> - <br /> afions:-------------------------- ---- - <br /> --- -- --- -- ------ -- ------------ --------:-------- ---------.__ <br /> ---- -------- - --------- --: - ­­ -- 7----------------------------A------I_ <br /> - -------- - <br /> ------------ ---- -- 04_4A"4 i r <br /> --- ------ ------------ <br /> ---- <br /> ------------------------ -- - ----- Z�l - ------- ------V <br /> --- ---------------------------- <br /> - <br /> - - <br /> - - <br /> FINAL INSPECTION BY:-------- Date-----... �r- 4- ------------------------------- <br /> SAN ---------------------- <br /> 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 /> .1-51 Revised W-2)00 <br />