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V <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. .7_ ._` ._.... <br /> .� (Complete in Duplicate) Date Issued <br /> - r <br /> ^plica+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 /> JOS ADDRESS AND LOC A ��� Ct-''vt e- --------------------------•----------------------------------------•--------- <br /> Owner's Name ¢ "-*��------ •- <br /> -------------------- ------ Phone------------•--------- -------- <br /> Address------------------------------------------------------------------ �----- _.__... t <br /> Contractor's Name.. ___._ _L__� ----- T - Phone_ - <br /> Installation will serve: Residen Q partme t House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other ❑ <br /> Number of living units: _�-_-__ Number of bedrooms .—"T- Number of baths ._1____ Lot size -__$ -------- ------------------------------------------ <br /> Water Supply:- Public system 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 [3--I-iffirdpan ❑ <br /> Previous Application Made: Yes 14 +4o ❑ New Construction: Yes E�—�o ❑ , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.} ` <br /> V. C" <br /> Septic Tank: Distance from nearest well*d.�4__Distance from foundation------I'd....___.Mater I ______________________ <br /> ,�f -" '. Liquid depth -• --- --a P y- �r <br /> No. of compartments-..-.-.._�_�_`.___...._-5ize__�_: ._'_...._.Ca acct <br /> Disposal Field: Distance from nearest well--!�_0�"t4-Distance from foundation__ --.D_.._____.Distance to nearest lot line_______ <br /> Number of lines----- of each line__ - ZWj�`+JWidth of trench.---���_--__._________._ <br /> Sd, -----Total length-------•-7=s --------------------- <br /> Type of filter mate�ial___�_��__Depth of filter material-___-__� .." <br /> t <br /> Seepage Pit: Distance to nearestDistance from foundation___-_-_$." _f_.. Distance to nearest lot line_`_c �___ <br /> Number of pits----_--_j-----------Lining material___Orr -Size: Diameter_---_-�.6-------...Depth------- _ ______________ <br /> Cesspool: Distance from nearest well________________ Distance from foundation------------------- Lining material-_..____:______________________.__ <br /> 0 Size: Diameter----------------- -----------------.Depth---F ----------------------------------{,--'----Liquid Capacity------------------------_--gals. <br /> F Privy: Distance from nearest well---.--------------___------------- --_____--._Distance from nearest building___---------_._--_______________---_.___. <br /> ❑ 'Distance to nearest lot line----------------- -------- --•----------------- -----=-------=-•--•---- ------- =--------._---------------•--------------------------- <br /> Remodelingand/or repairing (descr'ibe):----------------------------- ---------------------------------------------------------------------.------------------------------------------------- .... <br /> --•---------•-----------••--------------------------------------------------- <br /> f <br /> ---------_---------------------_---------------------------------------------------------_____+________-___f________------._.______...----- <br /> _____________________________________________________________________________________________________________________________________________________________________________________________________________________________ <br /> I hereby certify that I haveprepared this application and that the work will be.done in accordance with San Joaquin County <br /> ordinances, State laws, and rules a, rregullallons of the San Joaquin Local Health District. <br /> - <br /> (Signed)--------------- Septic-dank Service ------ ( er and/or Contractor) <br /> 1206 So. Eldorado ti0 -7045 <br /> By:------------ � -•-----_-----------Stockton,-Calif----------� e)------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, b dings, etc.(can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY r-� <br /> APPLICATIONACCEPTED BY------- --------- --------•-_--------------------- -- -----------------------------------•- • DATE--------2,�------------- --------------------------------- <br /> REVIEWED BY - DATE <br /> PERMITISSUED -�' - ---------•----------------------- DATE ------- n----------------­-­--- <br /> BUILDINGAlterations and/or recommendations:------ <br /> t •---------------•---------•-••----•------------------------------- <br /> ------------------•--------------------- •-- ---1... ------------------------------------ - ------------------- <br /> ----------------------------------------------- <br /> FINAL INSPECTION BY----------- --- ---• -- ----------------------• Date----- 1 ---------------•------ <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 149446 nTwaoo 12-94 <br />