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A15010- CATION FOR SANITATION PERalT Permit No. -__6.. .. -_ ...... <br /> (Complete in Duplicate) /Issued /! j <br /> i <br /> �x <br /> )Aplicaqon is hereby made to the San Joaquin Local Health District for a permit to constructand install the work here' de ribed. <br /> application is made in compliance with'County Ordinance No. 549. �z�o (0� <br /> «� n t <br /> JOB ADDRESS AND LOCATIO =. = - ,t.' _ S7`' <br /> ,O -------------°--- <br /> Owner's Narne....l..�l-�t--- s r � ----------------------- --------- ----------------------------- Phone......------------... <br /> Address-------------------------------------- ------•------ <br /> -- - - - ----------!•-••-- <br /> Contractor's Name --------------------------------------------------------------•------------- --...- Phone/_10._'.�r'. ._!._ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercialrailer Court ❑ Motel p Other E <br /> Number of livingunits: ___._.__ Number of bedrooms _.------ Number of baths .. <br /> �_ Lot size ----�-���- -� �--�--ti--------•------•- --_.. <br /> Water Supply: Public system ^'Community system ❑ Private ❑ Depth to Water TableTv 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 [9� --A+Few Construction: Yes [�-•-F*fo ❑ <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. -_ <br /> P - C-to----•- -.Material----- -- -- ---------- --------• ---- -------- <br /> No. of compartments-.-____. 11' <br /> �... 5ize. ..L Liquid depth.. 16 -----------Capacity---�At� <br /> Disposal Field: Distance from nearest welleX7rO, �.Distance from foundation--- ------------Distance to nearest lot line...( .f_... <br /> Number of lines------/--------- Length of each line------ 0--- -------------Width of trench------ -1 -�'-------------__-.- <br /> T e of filter material__/.��_ _---------De Depth of filter material....__ <br /> YP � P ��'---�--._.Total length---�`J-0------------------------------- <br /> Seepage Pit: Distance to nearest weff.. � Distance from foundation__-: 0_�_..._.Distance to nearest lot line. ^ V <br /> iA�y -----.----- <br /> -- Number of pits..----I..............Lining material-_- ----Size: Diameter----AN.-`"-------Dept n---. G-"_ -- <br /> Cesspool: Distance from nearest well-------__-...._Distance from foundation--------------_-...Lining material._.-------------._ <br /> ❑ Size: Diameter-- -- <br /> ---- <br /> 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 /> ---------------­----------4-- <br /> ---•---•------ •--------------------------------•--- Q <br /> --------•------••---------•-•--------•--------------------------•-------------•----------------------------------------------------•-••-----'` ----------------------------•---- - ---- <br /> -.__..----••-•-•-----•----------------------------------------------------•------------•--------------------------------------------------------------1 <br /> -------------------------------------------------------------••--•------------------------- -----------------------•--:------------------=•--•------------ ------ -------------------------------------------------------- M <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 /> - - -------- - - - '- <br /> � - - - (Q�rne�aqd[ar Contractor)3- . <br /> ---------------- - - <br /> BY: - •---------------------------------------------------------------(TitleP------------•----------------------- -------------------------- <br /> r< (Plot plan, showing size of lot, location of system in relation to welis, buildings, etc., can be laced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..............------------------------- VjB-------------------------------- DATE------------l j J9- f "- 5-•------------ . <br /> REVIEWED BY --------------------- ---------------- DATE <br /> ------------------------ <br /> BUILDING PERMIT ISSUED---------- -------------------------------------------------------------*----------------------- -- DATE----- <br /> - ---------------------•------ <br /> Alterations and/or recommendations:------- ------------------------ --............ <br /> ~-� <br /> •-----------------------•------- <br /> ----------------••-__---------------------------•--- - ----------- ------------------------------ <br /> ---------------- --------------------------...•---------------------------. <br /> FINAL -INSPECTION BY: Date <br /> ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California M Manteca, California Tracy, California <br /> Er -9-2M 145446 ATWODO 12-54 <br />