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tom„LICATION FOR SANITATION PEfo,,.,i Permi. No. <br /> (Complete in Duplicate( .1A <br /> Date Issued --...-..-..V:F7- <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. E <br /> JOB ADDRESS CATION---`�'.z-.D_ �-'.� �-G-LYLCl-11 1 ..- ---------------------------- --- ------------ <br /> Owner's Name ��u� -C�-- —h--S--�--,�-...... . ..------------------------------.. Phone------------------------_-- <br /> Address - ----------------------- --------------------------------- -- .... -- _ <br /> --.. _-- - - <br /> ---------------------------- -----._...............------- <br /> f� Q <br /> Contractor's Name... y. 1 ` - - ` ----- -- <br /> LL - - - - -------- Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -'Y- Number of bedrooms -..'1,::'Number of aths _..'Y Lot size <br /> Water Supply: Public system El Community system El Private Depth to Water Table Sift. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Lyam ❑ Clay ❑ Adobe�ardpan ❑ <br /> Previous Application Made: Yes ❑ No II�Q/New Construction: Yes ❑ No ❑ �/J/ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: _` <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S is Tan Distance from nearest well.- --------------Distance from foundation--------------------Material .-----_-_....__----------------..-.._.-_. <br /> No. of compartments..........................Size.-.---`----------------------Liquid depth-------- __--------.--Capacity------ ------------ <br /> osal jqld�_ Distance from nearest well -Distance from foundation---------_....__.Distance to nearest lot line._._-.._..._- <br /> Number of lines-------_._--- ___-----__-_Length of each line-----------------------------Width of trench.- ---____.---_------..--_- <br /> Type of filter material-------------------------Depth of filter material-...-------- Total length_--------------._.__-.-----.--0-.� <br /> Seepage 't: Distance to nearest well---�. -.--..-.-Distance f om f ndation--- --- .D' tan oto nearest lot line..l--..--.-- <br /> Number of pits_---�-_____Lining material _ _ y_.Size: Diameter_--s ----Depth tom_ _ - � <br /> fit�� - - <br /> Cesspool: Distance from nearest well.__._-____-Distance rom foundation_______.__.Lihing material-___----------_----------------_ <br /> ❑ Size: Diameter---------------------------------.Depth--- ----------------------------------- ------------Liquid Capacity----------------------------gals. p <br /> Privy: Distance from nearest well----------------- -------_-----_ ---- --- _-Distance from nearest building___._------------------------------- C <br /> ❑ Distance to nearest lot line---------------- ------------ ---------------------------'.............------------------------...------------------------------ ------ <br /> Remodeling and/or repairing (describe):_ --- ------------------------- ------- --------- '------ .--------------------------------------------------------------------- <br /> ............------------------------•--------------------------------------------------------------------------------------------------------- ---------------------- ------------•-------------------------- - <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 g0rd,i�tions of the San Joaquin Local Health District. <br /> (Signed). ._---------_SePtic Tank Service - -- ----- ----- --_--- IG4~-eael�oaContractor) <br /> 1206 So.Eldorado-HO247046 --- <br /> By .............Stocktcx Splif' — — - -- f -- - - (Title) P._.e-f n ------------------- ... <br /> (Plot plan, showing size of lot, location of system in relation wells, buildings tc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ---------- ---------- : — - -- ----- ------............--- -- -- DATE---- ---�.e l------------ ------ -------------- <br /> REVIEWEDBY------------------------------------------ -------- ------------------------------------------------------ DATE--- ' - <br /> BUILDING PERMIT ISSUED-----------------------_ ------------- --------- DATE-- -�- � C <br /> Alteratio /or r commendatio s:....------ - - — ------ - _.._ --- - - ' - '- -- <br /> - "° • -�. - --------------------------- ' --------------------- ---------------- ---------- <br /> FINAL INSPECTION BY:---_-.S--------------- ---- Date-- -_`_- _ —.67 <br /> - - --- --------.._.._.-. <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 />