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APPLICATION FOR SANITATION PERMIT Permit No. ., Z.__._.... <br /> (Complete in Duplicate) / <br /> Date Issued 'Z � <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1 <br /> This application is made in compliance with County Ordinance No. 549 <br /> JOB ADDRESS AND ..�........ ` v ? ...... .... <br /> --------------•------•-•----- <br /> Owner's Name. r ---------------------------------•--- --------_.................... ------- Phone---------- ----------•-••--- <br /> Address �i .. ----------_-------.---•--••-•-------------------------------------•---••-------------------.-•-•-•----•--------------------. <br /> Contractor's ! <br /> ' .. .. ....................•---...........-'---._..._....--'----...........---•--•-••-•--••---...---.._..__ Phone----�=�-•-�-.��-- -�'--.. <br /> Installation will serve: Residence EJ- -Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J---- Number of bedrooms ..;/__. Number of baths --- ... Lot size ...,/C_..)L..._%_-�Z.a _ I <br /> Water.Supply: Public system-0---Gommunity system ❑ Private ❑ Depth to Water Table S.k ft. <br /> Character-of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe C}--f^Far 1pan ❑ <br /> I: <br /> Previous Application Made: Yes ❑ No w Construction: Yes ❑ No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept Tank; Distance from nearest well_________________Distance from foundation--------------- <br /> 77Jj .._..Material--------•---'------•----'----•-•----'-----'----.. <br /> . —,; `�✓ "Liv:^z No. of compartments-------------------• --...size...-­-------------------------Liquid depth-------------- -----------Capacity....................... <br /> Disposal Field: Distance from nearest well,-- --_Distance from foundation------ -Cf---------Distance to nearest lot line._./--(____'.._ <br /> Number of lines........... ___. ' Length of each line----- 1!__.:w-----------Width of trench......�,---ir�-!.'-..-- „•,--..Type of filter material_--- -_.,,,_____ D--__._. epth of filter material----,/_j._-.........Total length____.....j__e?.......................... <br /> Seepage Pit: Distance to nearest well_�4'. ..-�.-......Distance from fourdation...., ........Distance to nearest lot line_!.d'._____ <br /> r r _ <br /> [ -- , !Number of pits.._..!---------------Lining material.---C�-�c�_t...Size: Diameter---�,�----------._.Depth__..._�-.S__--...__..______••-- <br /> cesspool: Distance,from nearest well.................Distance from foundation--------------------Lining material..........___._.______...________-_. <br /> ❑ Size: Diameter...........--------------------------Depth------------------------------------------ ------Liquid Capacity............................gals. mI <br /> Privy: Distance from nearest well............... ----------------­----Distance from nearest building............................ <br /> ....____:__... <br /> ❑ "' Distance`to nearest lot line-........----------- _ rn� <br /> �I <br /> Remodeling and/or repairing (describe):......................................................................................... <br /> -•......................•---------•---.._..------.....------•-------------••-•-----.......-------------------------•------• -----------------------••----=•--------------------•-•------ 3 <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 /> ? .........................................._-- --------------- <br /> ---- Contractor) <br /> (Signed) ... <br /> By: _'lL.!_� .r.L�-� _ _: -•-•-..............................................(Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.__� 1 c:;;- ----------------------------------- RATE ' -�� -- ------------------------------------- <br /> REVIEWED BY-------.'----•------•--•---------- DATE �`�.. <br /> - a---- <br /> BUILDING PERMIT ISSUED............................. ... '`� ------------- <br /> DATEr4::- <br /> ..............................•- <br /> Alterations and/or recommendations:....................... .... ---------------............................._........•--•••....................... <br /> -•••----...--•---••--•••.................. _ <br /> t1-. <br /> 4 ' - -------------------------------•------ <br /> ..........-•--•---•--•--••-- :------ <br /> -•-'......................................................................... .. <br /> FINAL INSPECTION BY:-:--=-'•----------- ---S�-------- -------•-•------ ......... Date...... _?........... <br /> 3..a <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Arnerican Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> Es----7m 145446 ATWOOD <br />