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A, (CATION FOR SANITATION Plilkhw Permit No. <br /> (Complete in Duplicate) Date Issued <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 A LOCAT N.. /.,9 .p- - - .....y ----------------------- -------------------------- <br /> Owner's Name -�---- - - - - ---------_ ------------ --------------- ----- ---..- Phone.-------------------------- <br /> Address...................... -- - -- ... - r <br /> - --- - -------- - ------- <br /> Name... _ � ----------------------- <br /> Contractor's <br /> -- <br /> Installation will serve: Residence/ R —rApartment House E] Commercial El Trailer Court ❑ E]Motel Other <br /> _f- ❑ <br /> Number of living units: _ Number of bedrooms L----0Jumber of baths ._I._ Lot size __-jT '�0' <br /> . .--- -- --- ---- ----------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private 1B'epth to Water Table -V ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe6--<ardpan ❑ <br /> Previous Application Made: Yes ❑ No law Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank: Distance from nearest well--- _...Distance from foundation_.._/.®_'..Matefiai <br /> o No. of compartments.. _ Size...S_} _ Xt._Q...Liquid depthCapacity_- . r <br /> -- <br /> . ... <br /> Dispal Field: Distance from nearest well <br /> /0_�_ <br /> Distance from foundation.-_-10-'.._Distance to nearest lot line...1,1....�.... <br /> Number of lines-_.___....._�.. .. Length of each line--------—11/0- ..__..Width of trench_....,L`(_____..._..._. <br /> Type of filter matenal. l-L._// Depth of filter materia L._..r ,}....._..Total length..._ ----------------------- <br /> Seepage <br /> ....._...._._._._.... <br /> Seep ge Pit: Distance to nearest well..._/d.4--- ._Distance from foundation,.....3_.4........Distance to nearest lot line__15--- _ <br /> I� Number of pits---------- ------.,_Lining material_,R_rK-1-Size: Diameter-.73--- .._----Depth_ <br /> Cesspool: Distance from nearest well-------------_Distance from foundation....................Lining material ----- ----------------- <br /> .--------- <br /> ._. <br /> F1 Size: Diameter-------------..-..--.---_Depth--------..._------.-.---------------.-Liquid Capacity_-----------------._-.gals. Q <br /> Privy: Distance from nearest well----_-------------------_------____ .......Distance from nearest building------------------_.___.__.._.._..._. <br /> ❑ Distance to nearest lot line----------------------------------------------------___..-------------------------------------'------------------------------------ rN <br /> Remodeling and/or repairing (describe):...... ------------------------- -----------------------------_------'............................................................................... <br /> ------------------------------------------------'------------------------------------'---------------------------.......1--. .......------------------------------------------'--------------------------------- f V <br /> -------------------------------- <br /> - <br /> . N <br /> ------------- ------------- <br /> I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, S laws, red rule d regul tions of the SS51pn J <br /> ,o <br /> -aquin Local Health D' rict. <br /> (Signed) .. <br /> - - - L `�-� - �. - - - -- ' - Contractor) <br /> -- <br /> By:......... . ..... ...._. ..... .. `'�'2 - - - -- ' - -- ITifle). <br /> - - - - <br /> (Plot plan. showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse sidej. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ ..............._---- DATE... <br /> REVIEWEDBY---------- ' - -' - ------------------ -----------.......--'--"-"----'-"----------- DATE-- <br /> ------ <br /> ATE- - <br /> BUILDING PERMIT ISSUED--- - -----------------------"------'-----.........._... DATE--------- - -- <br /> Altera+ions and/or recommendations:--- -- - ----------------------------------------------------- -....... <br /> - —`�j (" <br /> ..... ...... ......_._..... --------------------------.................... - --- - -- - - -- -------- <br /> BUILDING <br /> -- ------- ---- -- V ._...... <br /> --------- ------------ -------- ----- <br /> --------------------------------'---.............. '- --------- - --- ------------------------------------------- ------------------------------............-------------------------------------- <br /> ------------------- - -- -- -- ------..------ --------------- <br /> - -- - ' - ----------­-- - ---- <br /> ' -' - -'------------ <br /> FINAL INSPECTION By:_ --- .--- .---........--------_--------.. Date......- _ 1 <br /> - 3------------. ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M � Revised W-2100 <br />