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V11 W75 ^. <br /> ' APPLICATION FOR SANITATION PERI I , � Permit No. - __T -----.------ <br /> Co Tete in Duplicate) 1 i L <br /> v0 P P / I D }sued .------ ---6Y <br /> rD 2- <br /> Application is hereby made is San Joaqu�Local Dist for a permit to nstruct s allwork herein escribed. <br /> ANS Y SQA <br /> This application is made in compliance with County Ordinance No. 549. M4VWR mr{ <br /> y� �- <br /> JOB ADDRESS LOC TION D` ' ,/ <br /> � � ------------------------- -- - Phone--- --------- <br /> Owner's Name______ _ ________ ___ - <br /> ' ----------------------------------------------------------•------------ <br /> Address---!_.:�__a _._ .G1. --------------------------- <br /> _ <br /> Contractor's Name----------------� ----------- Phone---_---- �I-----. <br /> ------ ------ �t4� <br /> Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: /---_ Number of bedrooms _-Z_ Number of baths /____ Lot size Z04 0-' _____�--- •--r------------------- <br /> Water Supply: Public system ❑ Community system ElPrivate 9 Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobeA Hardpan [] F <br /> Previous Application Made: Yes ❑ NOX New Construction: Yes ' No,[:] y <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 weil____5�----Distance from foundation----1_4_�_-_-Matell____________________________ <br /> No. of compartments.._ ___Size__S 4-X_V40._Y S_f Li u id de th___.__ Ca acit d Q_ ------ <br /> D4al Field: Distance from nearest well-.._�_'_a-�.._Distance from foundation____-�.--__-.__.Distance to nearest lot line___.___ <br /> Number of lines----------- --------------------Length of each line_$_`-&a- °------.Width of trench_._._ __y. .---------------- - <br /> Type of filter material_Sd??0Vr------Depth of filter material-----/R-"-_____Total length-----1.90-11-------------------- <br /> Seepage Pit: Distance to nearest well__--------------------Distance from foundation--------------------Distance to nearest lot iine._____.__.__.-_. <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: Distance from nearest well-------------------------------------------------Distance from nearest building.____.__..__.___--_ <br /> ❑ Distance to nearest lot line-- -------------------- ----------------------------------------------- ------------------------------------------------------ -------------- <br /> Remodelingand/or repairing (describe):-------------------------------------- ---•-------------•------------------------------------------------------------------------------------------ <br /> --------- <br /> ---------------------------------------------------I-----------------••---------------------------------------------------------------------------------------------------------------------------------------- <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 District. <br /> (Signed) <br /> ------I Contractor) <br /> ----------- --- - -------- <br /> Owner and/or ontra <br /> f. (Title)--By=--------------- ! ------------- <br /> �"r ------- <br /> howin size Of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). <br /> [Plot plan, showing <br /> FOR DEPARTMENT USE ONLY _24 <br /> APPLICATION ACCEPTED BY---------------------------------------------------------- DATE <br /> REVIEWEDBY----------------------------------------------------- ---------------------------------------------------------------------- DATE-------- --•----•------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------- --------•----------------------------------------------------------------------------- DATE-------------------------------------------------------_ <br /> Alterations and/or recommendations------------------------------- ------------------•-----•-------------------------------•---•-•----------------- --------------------------------------- <br /> --------------­------------------------------------------- <br /> -..-------------------------------------------------•--•----------------------------------------- ------------------------------------------------------------------•--------.._---------•-------------- ---- --•- ------------------------------------------------ 57 <br /> -- <br /> ---------- ---- ----- ----------------------------------------------------------------C_------------------------------------------- <br /> FINAL INSPECTION BY------------------ _ If ----------------- Date------------------------------ <br /> SAN JOAQUIN LOCAL <br /> HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />