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r-UKUrhlLt USt: <br /> APPLICATION FOR SANITATION PERMIT Permit No. 1_7- <br /> 2—, . <br />------------ ---- --------------------------------------- (Complete in Duplicate) <br /> --------- - This Permit Expires 1 Year From Date Issued Date Issued .___..... <br /> Application is hereby made to the San Joaquin Local Health District for a r t t construct and install th ork eF,e'n described. <br /> This application is made in compliance'with County Ordinance No. 549. 3� ^ t .� <br /> JOB ADDRESS AND:-LOCATION.,.... - - --- -------- <br /> --------------- ------ <br /> Owner's Name -----. �??'�''�'�.•-- -- ----•• .. �---------------------- -----------------------------------------•- Phone----------------------------------- <br /> Address--------............•-._S� .8. <br /> Contractor's Name..................... ---------------------• -------•----••---------•---------------------------------•----.. Phone------•-------------••------------- <br /> Installation will serve: Residence)6_1'A rtment House ❑, /Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .-I.... Number of bedrooms _/Y. Number of baths ._-L._. Lot size ---TG�_� �� ��----------------__._____--_ <br /> Water Supply: Public system ❑ Community system ❑ Private Of Depth to Water Table �`7�ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No� New Constructjon: Yes ❑ No M FH /VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br />-Se tic_Tat<kr �-Distance-frorw-riearest -w'e �e/-"fro �foYuridat'on_}•_1:�Q._'.__:Mat <br /> No. of compartments.___'-__--___ Ie -' __r,_A...LI uid de +h________________ <br /> - � l Size---•----•-- q R ��--- Capacity..3.4!_©._...... <br /> Disposal Field,: Distance from nearei%Wne- ._Distance from foundation._.____-----Distance to nearest lot line..a ._ <br /> ❑� Number of lines-----------------------------------Length of each line------------------------------Width of french----------_---------------------- <br /> Type of filter material.-•----------------------Depth of filter material-------------•---------Total length----_....._..--------.-.-------------.-_-. <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line................. <br /> ❑ " Number of pits----------------------Lining material-----------------------Size: Diameter.---------..-----------Depth----------------_•-------------_. <br /> Cesspool: Distance from nearest well----------------- from foundation................___.Lining.material.---------------------............... <br /> ❑ Size: Diameter---------------------------------------Depth--_----------------- ----_-----------------------Liquid Capacity----------------------------gals.., <br /> Privy: = YZ-Distance-from nearest well""___--_ T-" ---------_'------Distance from nearest building --------------------------------- <br /> Distance <br /> ---_---__ _--...._.___.__._.Distance to nearest lot line-------------------------------------------------------------------------------------------------- <br /> QQ-- ,GeG <br /> Remodelin d/or r p ring (describe). CrQ� 1 � r . <br /> A. <br /> , 2.-- -i •- ----- ------- ---- ''�'t' �--------- <br /> t <br /> -' --------------------------------------- ----------- ......... --------------------•-•----•----------------------•---------------- <br /> h�v , at I have prepared this application and { { { e rk will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and',regulations of the San Joa uin' Loi l Health District. <br /> [Signed).. <br /> --�- ------ ----- ----------------------------------------------(Owner and/or Contractor) <br /> By:-------------------------------------------------- ----------I-•---------------------- ----•--- • --------------------(Title)......_--------------........-.--------------------------------- <br /> (Plot <br /> .------------- ------ ------ <br /> (Plot plan, showing site of lot, location of system in relation to we , b ildiinngs, efc., can be placed on reverse side)... <br /> FOR DEPARTME 'T IJ ENLY <br /> APPLICATION ACCEPTED BY---------- - • ----------- DATE.. <br /> REVIEWEDBY -----•-------- ---- --------------------•---- -- --- - ---� ---•.............. DATE---._. .._... _ <br /> BUILDING PERMIT ISSUED............................................... ------- ------- ------ ----------.._._. DATE <br /> Alterations and/or recommendations: ------------------------- ---- ........--------------------------------• ----•---------------•----------------------- <br /> ....-•-------------------------------------------------- <br /> Ift <br /> --------------- <br /> ------------------------------------------- ----------­-----------I----------------------------------------- -------- ----- ----- -----------------------------------------------------------------•--------------------- <br /> ---------------------------•-----.. ------------------------------ --•------------------------------------- --- ------ <br /> ED <br /> FINAL INSPECTION BY:. - Date---------------- 7n/0-:7_4 . ---------------=---------- <br /> SAN JOAQUIN LOCAL HE L DfSTRICT <br /> 130 South American Street 300 West Oak street 144 camore Street 205 West 9th Street <br /> Stockton,California Lodi,California Mant ca,California Tracy,California <br /> ES 9 REVISED 8-89 @M D-51 ATLAS <br />