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APPLICATION FOR SANITATION PERMIT Permit No. 7 - . ---- <br /> (Complete in Duplicate) <br /> 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 herein described. <br /> This application is made incompliance with County Ordinance No, 549. 7�`�'�: 7$— (SO j <br /> d EKF�SDtiJ oda <br /> JOB ADDRESS AND LOCAT ON------ _ _- --- - - -1-- - - -------- ----- <br /> Phoney� '" = ------------------------------------ <br /> Owner's Name``------ "' ------:L�. ------------------------------------ ----------------------------- <br /> Address II------------ = -•---------------i .....I <br /> .Name--- =---- I'hone----------------------------------- <br /> Installation will serve: Residence�] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 4 <br /> il <br /> ! <br /> Numbelr of living units: _1- Number of bedrooms __-_____ Number of baths ______ Lot size _ _ _ o <br /> Water Su <br /> Public system [I Community system El ]Private, Depth to Wafter Table 4.4-7 - ft. <br /> oil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [IClay ElAdobe❑ Hardpan , <br /> Character of s <br /> Previous Appl,, ' 11 <br /> cation Made: Yes ❑ No JE New Construction: Yes 4 No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted`if public sewer is available within 200 feet.) <br /> Septic Tank: ._. _ <br /> Distance from nearest well +9--1Distance from foundation__. .!b___._ __Material_.___ .____-__.-_.___.._._-_-. ' <br /> ! <br /> No. of compartments----- - --= ----- ----- <br /> ----------Liquid depth-----y ------ --------Capacity---1d-;2----------- <br /> Disposal Field: Distance from nearest wellt_.rlf—_---..._Distance from foundation__ 9-1?----------Distance to nearest lot <br /> 1 _ ...- - line___.._______ <br /> h-----� <br /> Number of lines-----a------ -------------- Length of each line-----�Q --------- ---.Width of trenc -------------------- <br /> ---------- <br /> Type of filter materia _. �. Depth of filter material-.-_,_1 '�.___-.--Total length-_--.-__4d'_________________________ m <br /> Seepage Pit: Distance to nearest well_---------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ Number of pits--------- ------ ---Lining material-------------r_­.....Size: Diameter---------- ------ - Depth----- ------------------------•+ <br /> Cesspool: Distance from nearest well______-----------Distance from foundation--------- .---------Lining material---------.__---,_-____.-_-__._-____- <br /> Size: Diameter-------------------------- ------ -- Depth----------------------------------- ---------------Liquid Capacity---------------- --------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------------- <br /> ❑ �' Distance to nearest lot line--------- ------ ------------- <br /> 3 <br /> I <br /> Remodeling and/or repairing (describe)---------- ----------- ---------------r ---------•-------•--------•-------••-•------------- •--------------------•-----....------•---•----------...-------- <br /> -------------------------------------- ----------------------------•-•-•--------- ------•------- <br /> I -----•-•--------------------------------•--------•-------- -••---------- ---- <br /> --------------11_-------------------------------------------------------------•-------------------------- ----------------------------------------------------------------------------------------------------- <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> -I� ---- ------------------------- {Owner and/or Contractor] <br /> {Signed]----�?-��.� ---------------- - <br /> ---- --------------------------------------------------------------(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 r>•_ -------•-----------•---------- ------------- DATE_?_�'.�.'4`Jx----------------------------•---- <br /> ------------- <br /> REVIEWEDBY--------------------------------------------------------------------- -------------------------- DATE------------------------------- •--------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------- ------ DATE-------------------••--------------------------------------- <br /> Alterations a`nd/or recommendations:-------------------------- -------••----------------------------------------- -•---------------------------------------------------•- <br /> --------•-----------------•--------------------------------------------------------•--• <br /> ------------------------------------------------------------------------------------------------------------------ <br /> I --•---------•------------------------------------------------------- <br /> ----------------------------------------------•---------- <br /> -1 ---- ---- ------------------------------------------------ ------------ ----------------- ------------------- -•---•-•••------------= -------•---------------------------------------- <br /> il <br /> FINAL INSPECTION BY. -------------- Date__. __ _ " ---------------------- �--------------- <br /> + / <br /> � 5AN JOAQUIN LOCAL HEALTH DISTRICT <br /> I ' <br /> t_ <br /> l30 South American Street 300 West Oak Street 132 Sycamore Street 8)4`North "C" Street <br /> Stotk+on, California Lodi, CaliforniaManteca, California Tracy, California <br /> ES-9 1115446 ATWOOD <br />