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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in-I Duplicate) Date Issued <br /> Applica4-ion is hereby made to the Son Joaquin Local Health,Dislrict 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 AND L0CATIO&__(9V,&7M�:V'I q...... Phone. <br /> Owner s <br /> hone-Owner's Name.___. <br /> ---------- -- -- ------- --- ---------------- --------------------- <br /> -------------------------- <br /> Address_-_------_-------------- C7 <br /> 01 ----------------- Phone----------------------------------- <br /> Contractor's Name---- ------------------------------------------------------------ I--------------- <br /> Installat Apartment House [3 Com 0 t 11ne <br /> ----- Lot size ------ <br /> rooms .02"7"Number of baths _4- ------------------------------ - <br /> Commercial E] -Trailer Court [] Motel ❑El Other El <br /> ,on will serve: R.sild�n).�� <br /> Number of living units: ---I---- Number of bed e 41—ft. <br /> Water Supply: Public system El Community system [I Private X Depth to Water Table Hardpan [1 4 <br /> I Sandy Loam D Clay Loam E] Qay El Adobe Ix <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El <br /> Previous Application Made: Yes El No� New Construction: Yes [I No a,4A-tl� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) <br /> (No septic tank or cesspool permitted if public sewer is -;;�---------w-4 <br /> ­ - M ------------I---------------------------------- <br /> D;fiance from foundation_" <br /> --c-T <br /> Tank:.1... ll jid depth--------- -------------- -Capacity----------------------- <br /> No. of compartments. ---------- - --------- Size-------------------------------Licli <br /> A-2--o' <br /> Dis osal Fiel Distance from nearest well-----(0-0..Distance fr'om foundation----- ---- Distance to nearest lot line <br /> Width of french----------A --------------- <br /> p ------- <br /> Number of lines----------l-.------ <br /> ine ----------/......... Length of each line <br /> Type of filter material__S..rA��t Depth of filter material------------ -----.-Total length-----4740 ------------- <br /> -------Distance to nearest bl line____._.-.cepa Pit: Distance to nearest well__________________ _ _Distance from foundation <br /> Size: Diameter----------------""-----Depth----------- <br /> El Number of pits._-------------------Lining material----------------------- <br /> a&Op ag�eFi Pit: <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__.-______________ Lining material--.---- --- ------/------- <br /> Size: <br /> -----/-------- <br /> i❑ ze: Diameter_,----- --------. -Depth---------------- Liquid Capac <br /> '7 <br /> rn,� A <br /> Distance from nearest building. <br /> Distance rm <br /> nearest well.--.----------- --------------- <br /> 0 Distance to nearest lot line--.... ----------------------------------------- -- <br /> --------------- <br /> Remodeling and/or repairing (describe):------------------------------------- --------- --------------------------------------------------------------------------------- I <br /> ------------------------------------------------------­-----------------------------------I----------------------------------------------------------------------------------------------- <br /> -----------I--------------------- ------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------- - <br /> -- <br /> I <br /> �x <br /> ---------------- --------------- -- ----I---------------------------------------------------------- -------------------------------------------- --------------------------------I----------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> �l of the San Joaquin Local Health District. <br /> ordinances, State la �, n rules n egulat, s n <br /> /jk;� V 'a T �( <br /> (Signed)2Y----- --------- ------------ ----------- --- ------------------------------- ___.__{Owner and/or Contractor) <br /> -------------------------•-------- -------(Title)--------------------------------------- ------------------ <br /> By:--------------------------------- ----_------------------- -- ------i-------------- <br /> rL <br /> on-reversersicle).- <br /> _et.c.,,can:,be.placed <br /> ,�bAwinq,size of-lo /caf�iion A-syst ?,in-relation <br /> i- Aowells,.�buildinqs, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY----------- --------- ---------- ----- ---I------- ------------------------------------------ DATE------------------------------- ----------- <br /> REVIEWED BY--------------------------------------- ----------- ---- - - -- ------- ------------------------------------- DATE---- ------- --- --_---------------------- <br /> REVIEWED <br /> -_------------I--------- <br /> BUILDINGPERMIT ISSUED-------•---------- -----------��__ _ ----••---------------•--1---------------- ----------------------- DATE------ ----- -•--------------------------------------------- <br /> Alterations <br /> ------------------------------I-------------- <br /> Alterations and/or recommendations:-__._...__------------- --------- ------------ ------------------------------------------------------------------------------- <br /> ------------------------------------------------------I--------------------------------- ------------------------------------------------------------- ------------------------------­----------------------- <br /> ----------I------I------------- -------------------------I------- --------------------------------- ----------------------------------------------------------- ---------I--------------------------------------------------- <br /> ------------­--------­------------------------------ - ----------------------------------------- ----------------- ---------------------- ------ ---------------------I.,-------------------------------------- <br /> ------------------------------------------------------------------------------------ <br /> --------------------------------------::---- - --------------------- ------ ---- ------------ -------- ------------I------- <br /> Date------------ ---------- ----------- <br /> --------------------- ---------- <br /> FINAL INSPECTION BY-------------------------- <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 /> E6-9-2M 145446 ATWOOD 12-54 <br />