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r <br /> APPLICATION FOR SANITATION PERMIT Permit No.'.'rq.ff.•-6 <br /> (Complete in Duplicate) pate Issued -_/f11- <br /> Applica�ion is hereby made to the San Joaquin Local Health.District for a permit to co struct and ins#all a r�ork he ein escr+bed. <br /> This application is made,-in compliance with County Ordinance No. 549. <br /> Illy <br /> ADDRESS A LOCATION L! _. - -- - ------------ <br /> JOB _ r <br /> :. =-------- - <br /> �r._=C__" _1- _ -------=-f`----- Pho e ` -� <br /> Owners Name-- -- - - -- �:-- .. - --• ----- -- <br /> Address-f 1' ° � �-� � r -! _ -- ---- <br /> 7 <br /> t 'M1 •--------------- ---- Phone <br /> 4 <br /> .__ --- ----------------------- <br /> e' <br /> Name__.__•.-!___. -- - �•-t� � <br /> AI <br /> -T .. & t. <br /> Installation will serve: ,Residence artmenf Hausa ❑ 'Commercial ❑ Trailer Gourt ❑ Mote Other r <br /> �' g. ---------------------------- <br /> Number of living units: __'__ Number of bedrooms _ ---- Number of ba <br /> __ __ Lot sizes- <br /> Water Supply: Public system ❑ Community system ❑ Privafie� Depth to Wafter Tablez�ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ it <br /> II <br /> Previous Application Made: Yes ❑ Nox New Construction: Ye;)< No ❑ , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 20Q feet.} <br /> », , .,.. <br /> ' � �-�J•--------.Material------- - ---------- ----- ---------------• <br /> Septic Tank: Distance from nearest well___ t%-___:Distancp from foundation_ <br /> _X -.Li uid de th--. -3---.Capacity z�G�1 <br /> No. of compar . -- �{� : -. -- I- q P• <br /> D iX �. <br /> I Field: � Distance from nearest well_______________ Distance from foundation_______._______.__.Dis#ante to nearest lot line_________--_____. • <br /> P _ --------- <br /> = ._.Width of trench_______________________-- <br /> ❑ <br /> Type P --,- Total length-------------------- -------- ----------- <br /> Number of lines-------------------------------- --Len Length of each ine-------------------------- <br /> a T e of filter material:______ _ 'F � (i <br /> •�„�- ----=----- - � <br /> Distance fr m ou atian--- __l1.___.___.Distance to nearest lot I• e-_� __1 <br /> Depth o iter material___ <br /> Seepa e Pit: Distance to nearest well_.__ -:-------; f <br /> Number of pits.-_�___:._---}__-__Lining materia_ <br /> -- --- ----Size: Diame#er__ ------ -----:Depth- 1 <br /> Cesspool: Dis#ante from nearest well_________________Distance from foundation.____.___--_._ ___.Lining material__.--.--____.__.__._--_______________q <br /> uid <br /> Size: Diameter----------------- --------------------Depth-------------------- <br /> e- <br /> --:----- : -- Caps_�tY :: _-; Vials <br /> Priv -Distance from nearest w ----------------------------------------- Distance from nearest building-----_.___________----------------•----� <br /> y _ .: <br /> Distance to'nearest lot line_ ------------------------------------------------ <br /> ----------------•1-------•--------------------•----------- -------•-------`-----•-----•- <br /> Remodeling and/or repairing (describe):----------- -- ---------- <br /> ` - - ----------••----------••----------- <br /> --------------------------------------- -------------------- , <br /> 4 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 la and rule and regulatis of the.San Joaquin Local Health District. <br /> E (Owner a /or.Contractor) <br /> r <br /> (Signed)------------- - •: �-- --•- ---- -- --�----=--------- <br /> - -------------- <br /> (Plot plan, showingY-e- <br /> lot, ocation"of system in relation to wells, buildings, etc., can be� ed on rev rse 0 <br /> i FOR DEPARTMENT USE ONLY <br /> A <br /> -- <br /> DATE - <br /> -•--------- ------ <br /> APPLICATION ACCEPTED BY----------°----------------------- - --`- -- DATE_____ -______ <br /> REVIEWED BY----------------------------------- ----- - --- --- ----- - -\- - - <br /> ' -------------------- DATE------- ----•--------------- ----------------------------• <br /> BUILDING PERMIT ISSUED----------------- ---------•------- - -- <br /> and/or recommendations------------------- <br /> --------------•--------------------•----------- <br /> --••----------------•----------- -- <br /> --------------------------------- <br /> --------------------------­ <br /> ----------------•;---•-----••----•----------•---- <br /> ----- ---------------------------------------------------------------------- <br /> - <br /> - --- - <br /> -- ------•-------------- <br /> Date----------- 1 <br /> - ._ ]_ <br /> FINAL INSPECTJON BY:.--"""---" --- -------- - 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Tracy, California <br /> `-,Stockton, California <br /> Lodi, California Manteca, California <br /> ES--9-2M Revised W2100 <br />