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_ <br /> APPLICATION FOR SANITATION PERMIT Permit Na. . I___ `rr <br /> (Complete in Duplicatel <br /> Date Issued _______� <br /> 1" A lica-lion is hereby made to the San Joaquin pp y q n Local Health District for a permit to construct and instal[the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. f� <br /> JOB ADDRESS AND�LOCATION__ tN_ 17 <br /> Owner's Name----------0�_17'__7�27JV/ _ ---------- Phone---------------J--------•----------- <br /> ' � d-- � . � <br /> Address---------------------- j <br /> Contractor's Name---------------- r9.PQI�/..� ----1l�1 ____-_- Phone /G .(;,/;, - <br /> Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: j---- Number of bedrooms --g-'Number of baths I_____ Lot size _X_ ,5 __________________ <br /> Water Supply: Public system ❑ Community system ❑ Private (f Depth to Water Table�, _ 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 New Construction: Yes ❑ No,K <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-------------- Material- _ _ <br /> __ _______.___-__--__________-- -_____--_____. <br /> ❑�tSNo. of torrartments- -----------------------Size----------------------. <br /> Alm p ._--_. <br /> ._------Liquid depth-------------- -- --------Capacity----------------------- <br /> � J r <br /> Disposal Field: Distance from nearest well.r------Distance from foundation__/__�___--------Distance to nearest lot line__e <br /> Number of lines___ ----- --------------Length of each line___-40--___ ____-------Width of #Tench �`__________________ <br /> �r lr <br /> Type of filter material. - 0,/_'__Depth of filter material_._._/9________.Total length____�Q`_______________ ____________ <br /> ` �f <br /> Seepage Pit: Distance to nearest well �...� _____Distance from foundation_��_.-_..___.Distance to nearest lot line_______________` <br /> Number of pits._Q?-+R..r:_.___ ining material---0At_CrX Size: Diameter_'.---____Depth_; ----------------- <br /> Cesspool: <br /> _______________ <br /> Cesspool: Distance from nearest well----------------- from foundation-_______------------Lining material-_._____________________.__---__-___. <br /> ❑ Size: Diameter---- ---------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------g <br /> Privy: Distance from nearest well----------------------------------------------- _Distance from nearest building--------------------------- <br /> --------- <br /> _.._. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------=-•----------------------------- <br /> Remodeling and/or repairing (describe): - 4; ---- -------'---------•-------•---------------•---------------- <br /> ------ ... <br /> --------------------------------4 <br /> ------------------------•---------- -----------------------------------------• ----------•--•----•---------------------------------•--------------------------------------------------------------------------------------- <br /> I hereby certify tbat..l_hav prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State'aws, n�l and regula ' s of the San Joaquin Local Health District. <br /> (Signed)---- -- ----------i --- ------------------------•-------------(Owner a /or Contractor) <br /> By:- --••-----f--• -- ---- --- - --------- �--- ------ -- -- -l-------------- <br /> (Plot �-onr,,,rse <br /> ' <br /> plan, showing size of lot, location of system in relati o wells, buildings, etc., can be pla side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY- --- ------------------------------------------------ ------------------------------- DATE_ --------------------------------------------------- <br /> REVIEWEDBY ----- -- -----------------------I--------------------------------------------------------- DATE------------•---------------------------------------- <br /> BUILDING PERMIT ISSUED----------------------------- ---------------------------•---------------------------------------•--- DATE------ <br /> ----------- <br /> Alterations and/or recommendations:- ---------------------•-••----------------------•-------•----------•-------------------------------•-•------- <br /> ------------------•--------------------------------•--------------------------------------------------------------------------------•------------------------•-- --------------------------------------------------­­----•- <br /> ---------------------------------------------------------------------- -----------------------------------------------•---••----------------------------------------- -------------------------------•-----------------•--- <br /> ---------------------------•-•------------------------------------------ ---------•-------------------- --------------------------------•----------------------•-------------------------------••------------------------ <br /> ------------------------------------ ------ ---------------------------------------------------- ------------------------.------------------------•----------------------------------------------------------------------..._ <br /> FINAL INSPECTION BY ,��� ----------- ------ Date-------- ----- L 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Proof 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M : Revised W-2100 <br />