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A,,..,LICATION FOR SANITATION PEF,..T, Permit No. ...... <br /> /I (Complete in Duplicate) <br /> Data Issued ..... I. ! <br /> it Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and/ y�fall th work herein described. <br /> This application is made in compliance with County Ordinance <br /> ,QNo. <br /> �54-9.-/� 5%!' �1 <br /> JOB ADDRESS AND LOCATION___.. _ ------ _f/1 ..........J iclr�.9,�yt..--. _. <br /> ` .. .. <br /> Owner's Name-'`- :... :. � -­--------------------- ................. - Phone..............................- <br /> Address ----------- - - -- - . -- ,-- - .�: -•---------------------------------------------------------------------•............ <br /> � Contractor's Name------ - -- - ---- ------ ----wa!�3 - -----..___....---•------..........._. Phone.o?. .__4 . 4 ... <br /> Installation will serve: Residence W_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms ........ Number of baths ALO+ size ... -------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth.to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> V Previous Application Made: Yes ❑ No ❑ New Construction: Yes I�LNo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> v Septic Tank: Distance from nearest well./ ..r..Distance from found ion.... Q........Materi�---1. .�.,.`._ <br /> No. of compartments-------- •....._._...Size__. ji.., iquid depth. .__........._Capacity_, iT.-p__ <br /> Disposal Field: 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 ................. <br /> C Seepage Pit: Distance to nearest well..1".__.._Distance f om undation_. .P......._..Distance fp nearest lot line..r'/-_d_d�. <br /> Number of its...._ .._.. <br /> 4�/ �, p' .��._._...Lining material...�^f.!,.!:(�._�.oiamatec_.__.�..�..�....Depth_.,2.f.�......._... c� <br /> Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material...-..-_._____..___......._..___ ,At <br /> ❑ Size: Diameter--------------------------------------Depth......----------------------------------------------Liquid Capacity...................... --gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building......................_................... O <br /> ❑ Distance to nearest lot line--------...----.................................................._......----......•--.........-----..__..------------------- <br /> LRemodeling and/or repairing (describe):................................... .............--.................._... -- - -- —...........------- ------. <br /> ------------•----------------...................................-.........................----•---....-..---•---------------------------- ......................--....................-------- �V <br /> L ---.......-------------------------------------------------------•--------------------------------------------.....--------------------------------------------•------------------- --------- <br /> ............-....._--------------•----...---------------- ---------------------- -----------------...----- ----------------------------------....--------------------------._...----------- -.._... <br /> 1"hereby certify I have prepared this application and that the work will be done in accordance with San Joaquin Counfy <br /> ordinances, St nd rules and regulations of the San Joaquin Local Health District. <br /> L (Signe -� - - - - _ . (Owner and/orrContractor) <br /> - -_..- <br /> By: .-- --- -- - . ... - - ..............................(Title)----..G rJ�:.:".-------...._........-------- --" <br /> (Plot plan, owing size o lot, Iota#ion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> L APPLICATION ACCEPTED BY--------------------- -------------­---........................ DATE...— <br /> REVIEWED BY.. .. _... _......... <br /> --------------._... .- _..._..- - - - DATE...-...... - - <br /> BUILDING PERMIT ISSUED -\-�- ---------•• <br /> Alterations and/or recommendations . A �� <br /> L ------ ---.........................--------------------------- <br /> ------- <br /> — — <br /> --- <br /> � - ----------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:..... .................. •----- Date....... ........................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT PLATE 5 <br /> 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C' Street <br /> Stockton, California Lodi, California Manteca, California Traey, California <br /> ES-9 T WQQa <br />