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�W S� wp� I 7�:Z_ - - , , ­;--� <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._fl-4__7J....... <br /> el /10 (Complete in Duplicafe) <br /> . Date issued -.__/��:j__._ <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 LO AT ON------------—------------------------ -----` � <br /> --------- <br /> ----------------------------- <br /> ------------------ <br /> Owner's Name ---- r- ------------------------------------- -------------- --------- .. Phone�d_3-9 gd 8 <br /> Address_ -- -- ......... <br /> ------------ <br /> Contractor's Name ----------- ---- + Phonal l Q � <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court.❑ Motel ❑ Other ❑ <br /> Number of living units: _f--_-_ Number of bedrooms ---/- Number of baths J-_- Lot size .-- --4__--_ ��t.Q _---------------------- <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table -7-a 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 ®� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if-.public sewer is available within 200 feet.) <br /> Distance from fondaion.-- --i- <br /> --_..Materi I----�Septic k: Distance from nearest well fe, J <br /> No. compartments <br /> _-•_- <br /> n , <br /> of compartments-- .�--__-._-____.Size-. --�� . - -��_.Liquid depth---� .�-------Capacity_ _10 <br /> p 1Q-�.-....Distance to nearest lot line--A-6 <br /> Dis osal ield: Distance from nearest wel� Distance from foundation.._ <br /> Number of lines------/------------ ----_--- -Length of each line--_- <br /> !!y, .r1.�--------- ----Width of trench.---°zy----- ------------- <br /> Type of filter material-SO RR.�.�C'Depth of filter material--_.._ -g ---..Total length___ ------------------- <br /> Seepage <br /> ------------- --- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line.---------------• <br /> ❑ Number .of pifs----------------------Lining material-----------------------Size: Diameter-----------------------Dept h_..-.-------_______-_____---_--- <br /> Cesspool: Distance from nearest well-----------------Distance 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 /> Remodeling and/or repairing (describe):------------------------------------------------------------------------------------k---------- --------------------------------------------------------- <br /> ----------------------------------------------------------------------•-------•----------•----------------------------•---....--------------------•• -•------•------------•----•------------••------•------------------------- <br /> ----------------------•-----------------------•------------------------•--------------------------------------------------------------------•--------------------------------------...----•----------------------------------- <br /> I hereby cprw,y that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, St t la` s, and rul s apd.regulations of the San Joaquin Local Health District. i <br /> ' {Owner and/or Contractor) <br /> (Signed)•-•---..... ------------------------------ ------ <br /> ----------- <br /> --- - <br /> . / 1 <br /> cl <br /> By: + 1 ---------- ! ----------(Title)--- --------------------------------------------- <br /> (Plot <br /> -------------- ------ h <br /> (Plot plan, showing size of lot, location of system in relation to wells, b Tidings, etc., can be placed on reverse side). 4 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--------------- ------- ---- - ---- - ------------------------------------------------------.- DATE--------------4-C-7 <br /> REVIEWED BY.------ ----------------------- �,( - DATE <br /> BUILDING PERMIT ISSUED ----------------------------------------------------------------- DATE <br /> Alterations and/or recommendations-------------- ------------------------------------•------------------ --------------------- --------------------------------------------I'll----------- <br /> --------------------------------------------------------------------------------------- -- -- -------------------------•----..----------•-----------------:---------------•-----------------......------•---- <br /> -----•--------------------------------------------------------- ------ ---------------------------------=---------------------------- ------------• •--- -------------------------------------------------•------------------- <br /> ------------------------------- --- ------------------------------------------------------------------------ --------- ------------------------ <br /> FINAL INSPECTION BY: , /// ------"-------- ------------- Date-- "o f ----•------------------------ <br /> y i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Americen Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> ES-9 145446 ATWgq❑ <br />