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Xt,P'( <br /> APPLICATION FOR SANITATION PEWIT Permit No.r�t <br /> (Complete in Duplicate) Date Issued -- <br /> Applica+ion is hereby made to the 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 /> //s v2, <br /> JOB ADDRESS AND LOCATION..........`--------------•-- ----''- <br /> Owner's Name..__... _ey�-- '� .....�P Phone........... <br /> Address.----- 1 t - Y••` . ......... - - ---- - --' - -'— V_. <br /> Contractor's Name.--"- " 2F '-/ --------_-----------_-------'------------------- -' <br /> Installation will serve: Residence E] Apartment House ❑// Commercial ❑ Trailer Court ❑ Motel ❑ Other Err <br /> Number of living units: _b_.. Number of bedrooms _(R v D x 3 �� <br /> -- Number of baths ----- Lot size ------------' -"--'- - " - ' ............. <br /> Water Supply: Public system ❑ Community system ❑ Private gj�Depth to Water Table 4,�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 gj- New Construction: Yes [rte ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ep - TQnk: Distance from nearest well_________________Distance from foundation....................Material-----------------------------------_-----_-- <br /> .�.� No. of compartments------------------._.....Size--------------------------------Liquid depth---""----------_---.-Capacity-__............... <br /> isRo Field: Distance from nearest well--__-_.___--_-_Distance from foundation____________________Distance to nearest lot line..._._._....... <br /> �Q Number of lines..................----------......Length of each line------.......................Width of french..________------------._._-_____. <br /> U Type of filter material.........................Depth of filter material-----___------------Total length.......................................... � <br /> Seepage Pit: Distance to nearest ____-_Distance <br /> l-7 from,fok ndation....SDistance to nearest lot line.....5------.-.-_-------.-Number ofPits_.._ ' ....Lining material.Sta34�4._.Size: Diameter___y,P..---------Depth----- 4------ <br /> Cesspool: Distance from nearest well.___..--__.-..Distance from foundation-------------.---...Lining material------------______-..._..-____---- <br /> ❑ Size: Diameter-------------------------------------Depth------------_------------------------------------Liquid Capacity----------------------'----gals. r <br /> Privy: Distance from nearest well________________.-____-_.......-___._____.---Distance from nearest building----------------------------............. <br /> ❑ Distance to nearest lot line-------------------- --------- "------"'---'-------------------------------------'-'------------'........-........--------- <br /> Remodeling and/or repairing (describe):----'-----------'-----------------------------------------------'__------------- --------..........---.....-.....-......—....... ;. <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 the San Joaquin Local Health Disfrict. <br /> (Signed}.----- - * -`y -- ''- ( and/or Contractor) <br /> By:.' '�_.-'--2 - ---------­- ' - - (Title)-' tLer.-i.t!" .l <br /> (Plot plan, showing size of lot, location of tem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------'-----------'-'--------------------' --- DATE............. --��� � -- <br /> REVIEWEDBY...............------------------------.---------------------------'.................. ------------------------------ DATE."'-""•................................................ <br /> BUILDINGPERMIT ISSUED..............................................................-...................................... DATE...._......................... -----------------........ <br /> Alterationsand/or recommendations----------------------------'-----------------------------------------------------------------------------..-........'-----------....-_......_...-_"'- <br /> "'-""--'-----""-"'-'-- '...................................'------------------------------------- ..--"""'-'................................... '.........----------'--"-""-'• <br /> -----------------------'----------....................................."--------------------------....------'------------------------ ...................................................._._.....----------'- <br /> ..... .--""'-'--------'•-"---"---"-"-'-"""-"---'-----------------..-......•-----'--"---------__-__--'--...............--------.------.-'----...... .................. -•--........ <br /> -- <br /> ."--'-"-................-. <br /> FINAL INSPECTION BY:. _--_-_--- .......Z1/ate11 -- Date. ---S "-'-"-"""-'-"'----'--'-•"---•- <br /> ------------------------------------- <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 />