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Permit No. <br /> APPLICATION FOR SANITATION PERMIT --( / <br /> (Comple#e in Duplicate) Date Issued ------ --- <br /> Applicaa-= is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance <br /> cee No. 549, <br /> JOB ADDRESS AND L CATION--V -0-6---e• —V h..=- ^'------------- t �---------fes <br /> Owners Name--------- <br /> ------ Phone.7j_ff.._ ® . <br /> Address-------------------------------- -------- ----------- . . ............------------------• --------------------------------------------------- <br /> -------- <br /> ------ ----------------------_.--_---_---------- <br /> Contractor's Name----------- P ----------------- Phone.---•---.--..----------- <br /> ._.. <br /> — ` <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> / - � , <br /> Number of living units: __Ime Number of bedrooms ----�Number of baths ___1'�_ Lot size _-_. _�-- �____-�D___-•--______ <br /> Water Supply: Public system Vcommunity system ❑ ' Private❑ Depth +o Wafter Table ._ dit. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam El Clay E] Adobe�iardpan ❑ <br /> Previous Application Made: Yes El No New Construction: Yes ❑ No ❑ � ow�P�tg� . Orrrp�� a 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> icTAhr— Distance from nearest well-________________Distance from foundation--------------------Material------------------------------._-____._______- <br /> No. of compartments-------- -- - - -- -------Size--------------------------------Liquid depth-------------- - - ---- -Capacity------- --------------- <br /> Di sal 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------------------------------------------ 0 <br /> See�e . Distance to nearest well..... from foundation_____f_S-_-___.Distance to nearest lot line______ ._ <br /> Number of pits-------I________._Lining mate ria l-"R:Cj-1:1„_Size: Diameter___- ._____Depth____�_.S_ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------------_--_----- <br /> ❑ Size: Diameter--------- ------------ ---------------Depth---------------------•-----------------------------Liquid Capacity- - •-----------------------gals, <br /> — a` <br /> Privy: Distance from nearest well-------:-----------------------------------------Distance from nearest building.---------------------------------------. / <br /> ❑ Distance to nearest lot line------------------------------------------ ----------------------•---- -------------------------------------- - -- r <br /> Remodeling and/or repairing (describe)-------- --------- --------------------------•-----------------------••----•-----•--••--•--------------------------------------------• -----•-------- <br /> ------------------------------------------------------------•-------••-----------•-------------------•----•----------------------------------------------------•-----•-------------•-•-------------------------------------- <br /> ------------------------------------- ---- ----------------------•----------------- ----------------------------------------------------••----------------------------------------------•-------------------------- <br /> I hereby certify th t I aye prepared this ap` lication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, rules and r ulatians of the San Joaquin Local Health District. <br /> (Signed) - ---------------- --- ;w4eells, buil�dlnq7s, ic., <br /> -- - ------------------------ � s r Contractor) . <br /> By:------------------------------------------------------------------------------------ ----------.(Title)- - ----------------- <br /> (Plot plan, showing -size of lot, location of system in relation can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------------ ------- - ......... - --------- -- ---------------------------------------- DATE-----------�---- ------------------------------------- <br /> REVIEWEDBY--------------------------------- -- ----- ------------- ------------------ -------------- DATE-------- <br /> BUILDINGPERMIT ISSUED------------ ---=-- -- ------------------------------•---- ------------------ DATE--------- � -- <br /> Alterations and/or recommendations:-=--------)----------- ------ - -- -----------------------------------------------------.---------------------- =_-------------------- <br /> - -------- ------------------------- ---------------••--------------------•--------------------------------•----- <br /> -------------------------------- �- j -- -=-- <br /> ------ ------------------------•- ---------------------------------- <br /> - - <br /> FINALINSPECTION 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 /> c5-7-2M 145446 ATWOOD 12-54 <br />