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(No septic tank or cesspool permitted it public sewer is available within ZUU teet.) <br /> Septic Tank: Dista from nearest well---1-QD_+.__Distance froi�wndation.__L--5.--_- -.Material-_-. <br /> No, of compartments-- - �X-- "a/Z /o� .p .. <br /> _ - -Srze- -- ---- £'"'`.- - -:_ )._Liquid depth --¢ i' ........Cap,cii <br /> Disposal Field: Distance from nearest well---N+_._Distance from foundation---171-------._Distance to nearest Ie <br /> Number of lines------_7-_--___-..___--___Length of each line-__--_LV_-Q__--....-- Width of trench ------- <br /> Type of filter material. �t,_f lick----_Depth of filter material--___l-et - .__Total length-------------- <br /> Seepage Pit: Distance to nearest well----_ ----------- ---Distance from foundation----................Distance to nearest Ic <br /> ❑ Number of Pits_----------- --------Lining material-_----------- --------Size: Diameter---------------------- Depth------ <br /> Cesspool: Distance from nearest well--------------- from foundation- Lining material------- <br /> El Size: Diameter----- --------------------------------Depth------------------- --'-----------------------------Liquid Capacity-------- <br /> Privy: Distance from nearest well,-------_ --------------------------------------Distance from nearest building--------------- <br /> ElDistance to nearest lot line-------------------------'-------'--'----------'----------'-----'--'---------- <br /> Remodeling and/or repairing (describe(:- <br /> .....- .-.----- -.. . --_-. -- -- - <br /> /j <br /> f � -------- <br /> - --------- --- ------------------ ------------ ------------------------------------- ---------.-.. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San . <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---� —�#�t ------ - µ (Ow <br /> ner and, <br /> By:__----- ----- <br /> ----------- <br /> ----------- -- ---------------------L------------------------ ----------------- ------ -----(Title)---7------------------------- ------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- .. ---------------_----------- ----------------- DATE.------- <br /> REVIEWED BY------_---------_-- 1 <br /> Y ------------------------------------------.- DATE.------ ------------_- --- <br /> BUILDING PERMIT ISSUED -- -------------------- --------------_------- ------...... ----------------- DATE. ------ - - <br /> Alterations and/or recommendation _ --------------- <br /> d7 _------------_----- ---_-_--_--- _y i <br /> 4,1 <br /> YW^ l �+-'t..['_il ✓ YYCJ.IL"-r..C. . Q "k_4J-} <br /> 42 <br /> FINAL INSPECTION BY:--------- -------- - 'F ----- --- ------------- Date------------- '...Z� - ....- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "( <br /> Stockton, California Lodi, California Manteca, California Tracy, Cal <br /> .., ES-9-2M 10-52 Revised W-2100 <br />