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AA AePLICATION FOR SANITATION PE MIT Permit No. ___�_ -,( --• <br /> (Complete in Duplicate) J <br /> Date Issued Y <br /> Applica4ion 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 /> i m <br /> JOB ADDRESS AND LOCATION__•--_3 �7 _ - <br /> ------- -- ------ - --- ------ <br /> Owner's - --------•--------------------------------•---•--- <br /> { Owner's Name_.--.U.______ <br /> - -- --------------�------_--- ------•-•-- --------- -•- ._.__. Phone <br /> Address_ <br /> X� <br /> Contractor's Name ------------------•- Phone_ ! • `�.Z G l <br /> - ------------------ --- - <br /> Installation will serve: Residence ��partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms -c2-. Number of baths /.__ Lot size <br /> Wafer Supply: Public system E Lommunity system [3Private ❑ Depth to Water Tab64/' ft. <br /> Character of soil.to a'de'pth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe B-19ardpan ❑ <br /> Previous Application Made: Yes ❑ No 94-"New Construction: Yes ❑ No B_____ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted-if public sewer-is available within 200 feet.) <br /> epti Tank: Distance from nearest welt_________________Distance from foundation---------------..-_.Material-_____-_--________--__.___..._.___________..._.. <br /> No. of compartments Size -------------------Liquid depth----------------- --------Capacity------------- <br /> D'spos field: Distance from nearest we.11__________________Distance from foundation__-.______..__:.__-.Distance to nearest lot line-______-•-.._-•_- <br /> • Number of lines-------------------------------------Length of each line---.--------___-•-..:._:;.....Width of trench.---------....---------••------_-.. <br /> Type of filter material-------------------------Depth.of.filter material:-----a ----Total length-------_--•-----------•------------•---•--' <br /> Seepage it: Distance to nearest well1Dista to frori ou !._ -dDistance to nearest lot line+ _�.__ <br /> __ <br /> Number of pits----- -----------Lining ma erial `-'-_ _, Di eter----- -----------.Depth-----a __...__.•-----__-- <br /> P -fo6u dad n-. . ------------Lining material--------------------•-------------••- <br /> ---------- <br /> Cesspool: izeaDiameter-nearest well -- ----Depth---- from foundatio^- -----------------Liquid Capacity-----------------.----------gals. <br /> PrivY� r - <br /> Distance from nearest well_-____.______ _____-_;__________________________Distance from nearest building------------------------•-------------- <br /> __. <br /> -. <br /> ❑ Distance to nearest' lot line____________________________ i <br /> emodeling and/or repairing (describe):--------- -----•-- ------------------------------------------ -------­­--•-----------•------ ---------•--•-----•- -R <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, atejaws, and rules and regulations of San Joa uin Local Healt District, i <br /> (Signed) et '� -- --_-_- <br /> i <br /> ---•-4 <br /> ----- ---- -- ------•- --•-------- - ----- --- --�---------:-------. ...---•---=--=- -=- ---------=•------- --(O er and/or on <br /> .---- <br /> Y• ----------•----------------- ...._:....._...-•-------------------------------------------=------••------•------._.(T'itle)---- ------------••-•-• -•-------------------------------- <br /> (Plot <br /> ------- tract r <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__________________ <br /> - - DATE__-3 ----------------------------------------- <br /> REVIEWED BY - �. DATE -----•---••--------•-•---------•-•-•-••- <br /> -----------------------------------------------------•- <br /> BUILDING PERMIT ISSUED------------------- _ _ <br /> -- -- . DATE <br /> ------•----• --- �-�---------------------•----•----• <br /> Alterations and/or recommendations:-------------- - <br /> ---------------------------- ....... ------- <br /> --------•----•----- -------------------------- ------•----------- _.---------------•-•------_-.---..----------------------••-•-----------•-- ------•-- -------•------------------ I <br /> ---------------------------- ------•-•------------------------ ----•------------------------------------------------------------------- ........-•-------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------- -------.........-----------------------•-=. ----------- -----•-••- <br /> FINAL INSPECTION ------------------------------------ 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 /> esu]—zfn 145ra6 nTwooa ,z-sg <br />