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�1 APPLICATION FOR SANITATION PERMIT Permit No. ...... « <br /> [ (Complete in Duplicate) Date Issued ._7"?-__`'� <br /> Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here-in described. <br /> This application is made in,compliance.with County Ordinance No. 549. <br /> 46 <br /> JOB ADDRESS A LOC TION. '-------------- y-fflM '-' -------------------- <br /> Owner's Name----- a -- ----- - -- ----- -- ------------------------ ------ Phone------:----------------------------- <br /> �.. <br /> Address--------------------- ----------------------- --- - -------=-----••----------- n 'k------------!-f............. ------------------ -• ---.-------------------------- <br /> IA <br /> 4 Contractor's Name.- ,----' nor.----- - ' ' "�� �- Phone---� t`7- - ---- <br /> ._ -------- -- 1 7 � <br /> x <br /> installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ lIa <br /> Number of living units: ___ ___ Number of bedrooms <br /> 1.10-Number of baths _�_�____ Lot size ------------------------- o <br /> Water Supply: Public system ❑ Community system ElPrivate ��Dep* t ater Table ft. <br /> -Character of soil to a depth of 3 fee+: Sand E] Gravel ❑ Sandy LoClay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: Yes ❑ ��No <br /> No T/ New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu�lic�fsewer is available within 200 feet.) �� <br /> fo" i nr�e from floundatian_1_ Vii` _.Mate ial--(�Tpzici;vff. <br /> ------- ---------- ---- <br /> -----. <br /> � J. <br /> Septic ank: Distance from nearest well___0-________ /,� <br /> I No. of compartments----------- .-------- .z - --�-`- c _..Liquid(depth--••----'.f............. _ : _` ------`I ` Nr. <br /> Dis as Field: Distance from nearest el �_____--.__Distance from:`foundation._ ___. ,.____. stance to nearest lot line__ __ ------- <br /> p Number of lines----------- _._ Length of each line---,,-____.[2_ _r ._.._.Width of trench__________ ___ ___tj ._._---_.-- <br /> Type of filter materia ____ .._----- epth of filter material __._�__�..______._Total length____________l.. __Q_________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line_.____-____.__.._ <br /> ❑ Number of pits----------------------Lining material_..-------------------.Size: Diameter_---------------------.Depth--------------------------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation----------------- Lining material_____.___.______.__________-____. _ <br /> ❑ Size: Diameter.._ ---- --- --. Depth ----- - ------- -----Liquid Capacity-------------------- <br /> L9415. <br /> Privy: Distance from nearest well----- ----------- ---------------Dis an from nearest building-___._____.__.__________....-------- <br /> ❑ Distance to-neares ine----------------------------- -------------•-------------•-••---------------------------/I----- ----------------------------- <br /> 3 ---- --- ------- _ _ .....---` `z --------------------- <br /> Remodeling and/or repairing ]describe]:__ -.a.-. <br /> --•---------- ------------------------------•------•------------------------ <br /> t _---------------------------------------------------_-------------------------------------Y._-__________-_-_-_.________----________.--.____.______._._._.___F_____________,_.-_____________.__________...__.__________.------- <br /> --------------_-----------_---------__y______.____________-..-.------------------------------------------------------------.-------------------------.-------------------------------------------------------------------- {'� <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun+ t "t1 <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> i {Signed) --------- -------- <br /> ---------- <br /> (Owner and/or Contractor <br /> By: `'----- (Title) ----------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relates to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-- ---------------------------------------------------------------------------------------- DATE------------------- --------------------------------- <br /> REVIEWEDBY------- ------------­------- ------------------------------------------ -------------• DATE---- -BUILDING PERMIT ISSUED-------- -------•------------------------ -------------------------- ------ DATE.--- c+='------------------------------------------ <br /> Alterations and/or recommendations:------------------------------ <br /> -------------------------•-----------•-------------------------------------- ------------------------------------------------------••----------------------------------------------•------------------------------------- - <br /> --------------=---------- -------------------------------------------- --- ------ ••----------• ----- -- -- <br /> s_ --6 <br /> FINAL INSPECTION BY:------- ---------- ------"`_------ Date_ ----------- -----�._ - � ..... <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 /> 4 <br /> .-es-e <br /> 145446 ATWOOD <br />