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AA 1 PPLICATION FOR' -,ANITATION PERMIT Permit No. .910.Z <br /> In V ,�1� ,�� (Complete in Duplicate) <br /> 4� � Date Issued <br /> plica+ion is hereby made fo the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> his application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--- 0-- - <br /> t-- <br /> --------------------- <br /> Owner's Name. _ Phone. � '3o ,3 <br /> ------------• ----------------------------------------- <br /> ---------------------- <br /> Address----------- — + <br /> Contractor's Name......S ----- ­ ----------------------------------------- ------ ------------ Phone Y''C1--. -. 3 <br /> Installation will serve: Residence n Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofee ❑/ Other ❑ <br /> Number of living units: ---t--- Number of bedrooms° ----- Number of baths ---1--- Lot size __-_--- ___--7�-• - r ---_-___________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .__..---1 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 [ New Construction: Yes [P�No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tan Distance from nearest weli-----------------Distance from foundation--------------------Material------------ <br /> .---_---.__------..---.."__--------. <br /> C- .t.c No. of compartments----------------- --------Size-------•----------------•-------Liquid depth-------------------------Capacity----------- ------ <br /> DisposalFi Distance from nearest well....------"------Distance from foundation---------___.--.-.-Distance to nearest lot line----------------- <br /> . � Number of lines---------------- -Length of each line---------------------------.-.Width of trench <br /> Type of filter material--------(---------------- <br /> Depth of filter material----------- ,____.-Total length-----------------------------__----_----- <br /> Seepag vPit: Distance to nearest ---Distance from foundation--4 �_e ..Distance to nearest lot line-"- -.-_-__ <br /> Number of pits_..L----------------Lining material--4-L6--------Size: Diam�Fer-----36.......-....Depth.-_-2-60--------- <br /> �-Cesspool: Distance from nearest well-----------------Distance from foundation__-_..._____----..Lining material----------- <br /> �j ❑ Size: Diameter---- --------------- -------.Depth-------------------------------- ------------_----Liquid Capacity--------- ------------------gals. �. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---"-------_--_-_-_•_--_-•._-.__._______. <br /> ❑ Distance to nearest lot line . <br /> Remodeling and/or repairing (describe)------- <br /> ------------------------------------------------------------------------------------- ---------­---------­--- •------- ..--- -------- <br /> ------------------•---------------------------- <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 /> r <br /> (Signed).:...�- --------- ----------------------------------- -- ------- -- -- = <br /> ----------------------------- <br /> Owner and/or Contractor) <br /> By:..- - -------------------1-J <br /> - --------•--------- ------(Title) .- 1 ------------------------------------ <br /> (Plot plan, showing size o of, location of sysfem in relation to wells, buildings, etc., can be placed on revefse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED'BY------------------------- <br /> ----------------------------- <br /> REVIEWE:D BY-------------- --- 1 <br /> DATE---- �- <br /> BUILDING PERMIT ISSUED------ - - -------- --•---- DAT . -- � ----- <br /> ------------ <br /> Alteratio0, dorrecommend tions: �'` --- ------ ----- i - --- -- --- <br /> --- --- --4 ------••----- ---------- - <br /> -�.-- .-7--- --- .� . - �° 2 - <br /> -- �----- <br /> 99 <br /> FINAL INSPECTION BY: - Date-----s;?- --- �.._ <br /> s' -' - 'r7 <br /> - -- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT i <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 /> IFS-9 145446 A7W04D <br />