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-....AICATiON FOR SANITATION �� Permit No. <br /> �'d ! Le <br /> (Co le in Duplicate) `�i y/ <br /> Date Issued .-----.-- 9 � <br /> Applica{ion is hereby made to the San Joaquin Local Health District for a per '# to construct 'stall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AP LOCATION-------2._�G.----✓Q: -------------- ---------------------------- <br /> f <br /> e--•--- G:�'vF �t ................ r _.....- ._--- ._..-- <br /> .............. <br /> one._...._.. r--- _. <br /> Name- ----- -- -------.•-�- <br /> Address_ ,�pl 00 <br /> Contractor's Name :L�=:-: s..._. �L:r�- I <br /> --------------- ----------- Phone. t.l__ -e;l .. <br /> Installation will serve: Residence (Apartment House E] Commercial ❑ Trailer Court I] Motel ❑ Other ❑ <br /> Number of living units: __/___ Number of bedrooms .-3-- Number of baths .-/_- Lot size --�_,,_ : -t 1- <br /> -------- ------ <br /> Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table Sb 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 p No [ New Construction: Yes Er-No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank- Distance from nearest well ......Distance from foundation._�t2..�_..._-,Material L - r_- fi;y__M(; <br /> No. of compartmenFs------'r2.. .... --------.---Liquid d �-epth---.- -U --- --- Capa <br /> Disposal Field: Distance from nearest we1l...S�...--.Distance from foundation.._./D- -.--•Distance to nearest lot line._ <br /> Number of lines-------./-------...............Length of each line----/.. .0-...............Width of french..... ��.-.-.-------.--. <br /> Type of filter material_%�C_�.-_._Depth of filter material /..�C..��_.-Total length.___l. r� ' <br /> Seepage Pit: Distance to nearest well...&&-'_--'/_-Distance from foundation.-_SA..........Distance to nearest lot line___ ._-t...._ <br /> Number of pits.._..._�..___._...._Lining material-- -.-..-.Size: Diameter.._.- __ ' " � ' <br /> �� Depth, `'f --------- <br /> Cesspool: Distance from nearest well.----------------Distance from foundation............ . .... Lining material..........._.__.-----------_- .- <br /> ❑ Size: Diameter- - ------ �--..........--- -- ....Depth------ ........................... ----Liquid CapacitY.---------------------------gals. , <br /> Privy: Distance from nearest well............. <br /> ----_._..........................Distance from nearest building <br /> ❑ Distance to nearest lot line......... ............ i <br /> Remodeling and/or repairing (descri€ie)-------------------- <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-jaws, and rules and regulations of the San Joaquin Local Health District• <br /> {5i ne <br /> gd}. ------------------- ...... -------------- - ----------------- -(Owner and/or Contractor) <br /> L_. -- - -----Title <br /> - - - -• --------------------- <br /> (Plot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - . ----}.-------------- ------------------------------------------------ DATE_. --- ------=--•---- <br /> DBY_ ----•---•-- ------------- -------- ----- ----------------- ---------------- DATE.............. <br /> BUILDING PERMIT ISSUED-------------- <br /> Alterations and/or recommendations:_...------- = DATE <br /> .....----•------• ._. ........_._---------------------- ----- - --- <br /> ................................. .............. •-------- <br /> ............................................. .........................................._ -"-`----•-•---- <br /> FINAL INSPECTION BY:----------- <br /> D <br /> . •.• I -:�-� <br /> .............................. ete_... _ ..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Ameriean Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> rs-9 145445 grw000 <br />