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1 APPLICATION FOR SANITATION PERMIT Permit No. ___ , -- <br /> i'' <br /> (Complete in Duplicate) o� <br /> Date Issued ______ _q3_ <br /> Applica+ion 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 /> JOB ADDRESS AND LOCATION------`� _>�- ---e�_-`---------------- -- - --- /�� L-- ..-----------.-------- <br /> /-� �� <br /> Owner's Name-----L�__1.6. �_:!_-------1 - -- ' ----•-----------------------------------•--•----------------------------- Phone----�'S �1- <br /> Address...... ,� ..� �----• -------- ----------- ---------------------------------------------------- - -------------- <br /> Contractor's Name 1. - - - 'z•fP --------------------------- •------•M---••---- Phone----L � <br /> Installation will serve: Residence j Apartment House ❑ 'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---4- Number of bedrooms . ___ Number of baths _ .V Lo' size --- -1- -4__C1__--____________________ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth�to-Water Tabled ft- <br /> Character of soil to a depth of 3 feet:I Sand ❑ Gravel ❑ Sandy-Loam ❑ Clay Loam ❑ Clay ❑ Adobe 5? Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes°x No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1 �,,,,,} <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' <br /> ep Ta'nk Distance from nearest well-----------------Distance from foundation__________________-Material_______________.___________.___-_______.__._____- <br /> No. of compartmentss-r--- - -----------------FSize_------•------------------------Liquid depth--------------------------Capacity_..----------------•-- <br /> {____._.--Distance to nearest lot line.-__�_-_____. <br /> Disposal field: Distance from nearest, we,L__7S.___._Distance from foundation___--_.._- <br /> Number of lines----------V-----------_____,_-_Length of each line--------3a_-__-__,_____.Width of trench______ _ ��-__.______'__._ O <br /> it <br /> Type of filter mate riaF_____',_e�Q�_�__Depth of filter material------ i_-___Total length-------.a-Q_ _________________________ <br /> i. <br /> Seepage Pit: Distance to nearest well-.4--n__._____Dist e from o anon---___________......Distance to nearest lot line__-______--______ <br /> V1 Number of Lining mat rial___--_-- _-- ize: Diameter-----3 ------Depth------ ----------------------- <br /> Cesspool: <br /> ----------------------Cesspool: Distance from neares+.well_________________Dis ce fro undation--------------------Lining material._----_____________._________________ <br /> ❑ Size: Diameter------- £F th Liquid Capacity gals. <br /> Privy: Distance from nearest well-----------_"`-----------_--------------------Distance from.nearest building----------------------------------------- <br /> F-1 <br /> _________._____________----._ ._---___._❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------•------ ------------ -------------------- <br /> Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <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 District. <br /> (Signed) - --------�L -!1_.µ_._!'_C' --`.__s — Y'_ � s -------------------------- . _. ___Ow r and/or Contractor <br /> By:.------------- �r <br /> (Plot plan, showing size of lot, location of syst7 in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------------------------------------------------- ---`- 3-------------------------- DATE---------. y <br /> REVIEWEDBY------------ ---------------------------------•----------- ------- ---- ------------------------------------------------------ DATE----------------------••-------------- -------••--•-------- <br /> BUILDINGPERMIT ISSUED-----------------------------------------------------------------------•----------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------.--------._.._._...._.._...... ----------------------------------------- <br /> - <br /> ---------- ---------------------------------------•-------------------------------------------------------------------------------------------------------------------------•---------------------------------------------— <br /> ----------------------------------------------•--------•----------•----•----------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------- •----------------- <br /> FINAL INSPECTION BY ^----- Date----------------3-~ <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 Manteca, California Tracy. California <br /> ES-9-2M ; Revised W-2100 <br />