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1'�'" �✓��y APPLICATION FOR SANITATION PERMIT Permit No. r, <br /> (Complete in Duplicate) S' <br /> � Date Issued <br /> Application 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 /> JOB ADDRESS AND LOCATION--------------------2°-1&---Kenyan----------.--------------------------------­----------------------------------------------------------------- <br /> Owner's Name----------X1 -- -D_oj- _t_hy_ JT�gki o.Tt---------------- -------------- �'-��81 <br /> - ------ Phone <br /> . me-----------------------------------------------------------------------------------------------------------------I------------------------------I---------------- <br /> 'Contractor's Name---=------------------D---e---I---t---a---------•------------ - ------------------------ -------------------------------- --------------- Phone-----_3-3-955 955 <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ____I Number of bedrooms ----2- Number of baths __I--_ Lot size .___2S�C7__7K �_4Q y <br /> Water Supply: Public system ® Communitysystem ❑ Private ❑ Depth to Water Table ------- ft. <br /> Character of soil to a depth,of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayE] Adobe [2 Hardpan ❑ <br /> Previous Application Made, Yes ❑ No [ New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND°.SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material <br /> __________________:________________________..� <br /> EXianing No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity-,--------------------- <br /> Disposal Field: Distance from nearest well------------------Distance from foundation,-------------------Distance to nearest lot line___________-----� <br /> ExisUing Number oflines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------- <br /> Seepage <br /> __________________--- _______________Seepage Pit: DistanceJo nearest well-----nolae------Distance from foundation---------1C1_Distance to nearest lot line_. _� <br /> © Number of pits__-.-------------------Lining material__-_bJr_:LD_k_-_ Diameter--3-6--- <br /> -Size: ____,_______.Depth____��_-__C---'r'__fr) <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______________---____________ <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------- Liquid Capacity 9 <br /> Privy: Distance from nearest well______________________________________________Distance from nearest building____------------------------------------------ <br /> ❑ Distance to nearest lot line------------- <br /> modeling and/or repairing (describe)____________________1115_ _c'3�.�7 11g._-����__�r�rt-iC_�__L�-r, 131__AYlly___and-_hpQk . <br /> to---- ti g �e t_i ---tarnk..WAth__so.1U_--line--------------------------------------------------------------------------------------- <br /> --------------- <br /> ---------------------------•-----------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- <br /> 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 District. <br /> (Signed)--------Delta------------------------------ ------------ ----------------------------------------------------------- --------------------(Owner and/or Contractor) <br /> I_arthara_ <br /> BY: -_Pfjri_y - --'-- --------=------------------------------------------------------{Title)--ownerna ---------------------------------- <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 /> REVIEWED BY------------------------------------ <br /> =- ------------------------------------ DATE `S----------------------------------------------- <br /> ---- ------------ <br /> BUILDINGPERMIT ISSUED------------------r ------•----------------------------------------------------------------------- DATE--- <br /> ------------------------------------------ <br /> Alterations and/or recommendations----------------------------- <br /> -------------------------------------- <br /> --------------- <br /> FINAL INSPECTION BY--- ----------------------- -- ----------- ------===--------- Date-- -------------------- <br /> SAN <br /> ---------------- .SAN JOAQ'UIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street u <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />