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rAAPPLICATION FOR SANITATI N PERMIT�,�` / Permit No. _____ <br /> i <br /> -,121-S (Complete in Duplicate) <br /> Date Issued <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 /> JOB ADDRESS AND LOCATION---_ C ' ' 1,-I)eJ�•----------------------•-------------------• -------------------------------- <br /> Owner's Name------------------------ ------ Phone---- =� <br /> Address._ --------------------------- _ - -----;;--;------------------ :---- ------------------------------------------------ ----- ---�---------------- <br /> Contractor's Name. t i_�► '-=�= �� •Il^�'f�G' Phone <br /> - -- <br /> i. <br /> Installation will serve: Residence CW Apartment House F1 Commercial ❑ Trailer 'Court ❑ Motel ❑ Other [3 <br /> ' a <br /> Number of living units: __�___ Number of bedrooms .71'_ Number of baths ___l__ Lot size ___ -_ _____ --'------------------ <br /> - , <br /> Water Supply: Public system ❑ Community system '❑ PrivafeR Depth to Water.Table Kp ft. ` <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E❑ Clay ❑ Adobe.5 Hardpan [❑ <br /> Previous Application Made: Yes ❑ No FgL New Construction: YesA No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> . �A-s--------.Material - <br /> Septic Tank: Distance from nearest wellc9b'o_-_Distance fro f ndation_ __ _ <br /> _____----Size_ " ' _Liquid depth- ` -2°..______ Capauity.� __ <br /> - s <br /> No. of compartments_____-_ n <br /> Disposal Field: Distance from nearest well62-0-r---__.Distance frA fatndation-------!-_6_'*-__Distance to nearest lot line-fd-:::�. [`r' <br /> Length of each line__�AO-------------------Width of trench------- -----__------ v_ <br /> • Number of lines-----�--------�--��--�-f- g - <br /> Type of filter material__!_Kir___Qk____-Depth of filter material__-J.9-r.• Total length-- _ -'______----------__________ <br /> Seepage Pit: Distance to nearest eIL -i -_ _-______Distance ro fou dation_ _Distance to nearest lot line-*D-- .. <br /> :� <br /> Number of pits__-----t- ---___Lining material___.- _ _ -Size: Diameter__ _ - ------.Depth___ - :---------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_---------.---------Lining material------------------------------------- {l <br /> ❑ Size: Diameter--------------------------------------Depth-------------•-------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building_____-____-_________________________-____. <br /> ❑ Distance to nearest lot line--------------------------------------------------------- ...----------------••------------------------------------------------------ <br /> i <br /> Remodeling and/or repairing (describe)------------------------- ---------- <br /> ----------------------------------------•-------------------------------------- <br /> - <br /> I ----------------------- ----------------- <br /> --------------- <br /> ---------------------------------------------------------------------------------------------------------- <br /> --------------I--------------­-------------:-----------------i--------------------------------- <br /> --------------------------------------------•--------------•--------•-----------------------i------•-------------------------- ------------------------------- --------------------------------------------------------------------------------------- <br /> 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 �nd regulations of a an Joaquino al Health District. { <br /> Si ned ----- -A-- ( Contractor) <br /> (Title) r <br /> By:.------ .� '�� '` ----�-�- ---------------------------------------------------- - - - - �"Y'�14 ; <br /> (Plot plan, show ng size of lot, location of syr stem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE�� <br /> APPLICATIONACCEPTED BY-- ---------------- --------- --------------------------------------------------------------- x' --------------------------------------------------- <br /> REVIEWED BY------------------------------ - DATE__." U� <br /> ---- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- = DATE - <br /> Aiterations and/or recommendations---------------------------------- ------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> r <br /> ' --------------------------------------- --------------------------- <br /> 1i <br /> FINAL INSPECTION BY:--------�--V ------------------------------ Date_ 7/y/ - <br /> F <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Worth "G" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 9-51 Revised W-2100 <br />