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rUrtUrrlc,t USE; <br /> ------------------------ <br /> J <br /> ---------------------- •� <br /> --- - - _.___ APPLICATION FOR $ANITATION PERMIT Permit No. ...�_ '` . <br /> +� - �- (Complete in Duplicate) _ r <br /> This Permit'Ex ices ] Year From Date Issued Date Issued �/7 <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 /> t. E <br /> JOB ADDRESS AND CATION of, _Z/0 <br /> Owner's.Name___ _ " -.��•- -"�__-- <br /> --------•-----------------------------••--- -----•----- •--•-------•------- ---------------••--- ; <br /> __ __ <br /> Phone <br /> F -•--------------------- ___________________ <br /> Contracfor's ------------ <br /> Name------ _ •-_- �. <br /> R - � - ------ -------- ------------- _ Phone----,...--•=------- <br /> -------------------------------------- <br /> 4 __ _______ <br /> Installation will serveResidence Apartment House ❑ Commercial- <br /> �`Traile� Court❑'�'Ma�tel ❑ Other <br /> 'Number of living units: Number of bedrooms . Number of baths . <br /> .. r <br /> „�. . F of size -•,f .lr Q_ <br /> Water Supply ' Public systerrl=:+ '�1Ccmmunify system ❑ PrivateQe th to Water Table <br /> D p SQ {t. <br /> Character of soil to a depth of-3 feet: :Sand ❑ Gravel ❑ SandyiLoam ❑ .Cla lLroam Cla t <br /> i 1,. �Y` ❑ Y ❑ Adobe la`rdpan ❑ <br /> Previous Application Made: {If yes,'date____________________) No ❑ New Construction: Yes Na 3 <br /> TYPE ,OF-INSTALLATION.AND,SPECIFICATIONS: ❑ CFiA/VA: Ye ❑ No ❑ <br /> No septic tank or„cesspool permitted,if,_public sewer,is aavaailab�le within <br /> l <br /> i <br /> an * Distance from.nearest well_________________Distance.from foundation________•____-_--- ___. ________•.------ <br /> Not of compartments________." r Material <br /> _ <br /> Size =------- --------------Liquid depth-------- -----------Capacity----------------------- <br /> r <br /> isp Field: Distance from nearest well_______________ Distance.from foundation------.___•___..__.Distance to nearest lot line.___:______.___._ <br /> Number of lines_1---------------------------------Length of each line_.----------------------------Width of trench------------ -------------_ <br /> ' Type of filter material.___ ------------ •- t.. ----•--- <br /> Depth of filter material__________________.__Total length_______--.______:_-____ ____ <br /> Seepage Pit: Distance to nearest well41datior4-2. <br /> ""' 5 "--- ---""'^ -"-""""f"-- <br /> _"-- "-_--DistanceFro <br /> ----..Distanc� to nearest lot linl___�Q---.._® Number of pits._-� __ Lining matriaze: Diameter__._.,, -----.Depth-- as--------•--=---------Cesspool: Distance from nearest well_______________ Distance foundation_------------------- inin material _`":_-_-t `l <br /> ❑ Size: Diameter---------------Z-- f --•----•---........ <br /> Depth --------'•- ------ Liquid Capaci+y.".....__i _ <br /> € � - - gals..Privy:. Distance from .nearestwell________________ _______ "___----_-_ Distance from nearest buisldin _ _ <br /> �iy..s, <br /> ❑ Distance to nearssf-lot line_______ <br /> ,Remodeling and/or repairing I (describe):______.___-___._____-.- k 1 <br /> : ----•--------.- ••--------•--- - <br /> .L ------- ---------- <br /> i <br /> -----••--•----------------•----------••---- •-------------- ----•-- �-------------.--•- <br /> - -----••----------------------•---- <br /> [ ! ,. s <br /> ---------­---------- <br /> --------------------------------------------•----------- --------••---------•----- I <br /> x <br /> ;----------- # ` -------------•---• ---••-•-----•-••---•------"----------------- ---"----- ------------------ <br /> y� I.hereby cerfify Wat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St ws,e.and r es and gulafions of the San Joaquin Local Health District. <br /> 9 <br /> (Signed)-- t 3 . <br /> �.. <br /> wrier and/0 <br /> e,g ( Contractor) <br /> ------- ----- <br /> -- [rile) <br /> ------------------------- <br /> (Pl <br /> ot p an, showing size of lot, location of system n ela ion to wells, buildings, etc., can be placed of r erse side). r <br /> FOR DEPART ENT USE ONLY <br /> a <br /> APPLICATION ACCEPTED BY____. <br /> i <br /> REVIEWED BY i <br /> - ------------� ---------------------- DATE------- " 2..7._._�(ca <br /> ---- -- DATE-------------------- <br /> - - -----I--------------------------------•----- <br /> BUILDING PERMIT ISSUED__ I"-- - ------•-------•----------- <br /> 7 ---- <br /> DATE <br /> Alterations and/or recommendafions:_ _ "' <br /> ----------------------------------------------------•------- ' <br /> --- ---------------------------- <br /> - <br /> - -------------- <br /> ---------•---------------------------- <br /> FINAL INSPECTION 8 {' r <br /> --- - -• ----1�----�----------1�.-,..-�� Dale-- -----•------�-=----- <br /> - - .'� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak StreetI <br /> 124 Sycamore Street 205 West 9th Scree} <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,Californ <br /> ES-9 REVIBEq a-99 F,P,C tl,2M 6.6a ' * � ` <br />