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APPLICATION FOR.-SANITATION PERMIT Permit <br /> (Complete in Duplicate} .Date Issued a-� <br /> Applica-1-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 in compliance with County Ordinance No. 549. <br /> JOB ADDRESS All\InOCATIOKOL.",� <br /> ------- ---------Ir----------------------------------- <br /> OwnersName.-----• ------------------------ ..... -------------------------------------- Phone------------------------------------ <br /> Address---------------------- ---- - ---- ---------­----­---- --- -- ----- <br /> 14 <br /> _to <br /> _0..9 <br /> _ <br /> Contractor's Name------ -­ -- -- --------- ------�7_1_ --------------------------- Phone- <br /> Installation will serve: Residence b Apartment House Ej Commercial [-] Trailer Court [3 Motel 0 Other 0. /&Lc_4� <br /> Number of living units: ___/__ Number of bedrooms ------.. Number of baths -------- Lot size ..... _____________________ <br /> Water Supply: Public system El Community system [] Private [W_ Depth to Water Table gkj ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam [_1 Clay Loam E) Clay E] Adobe FA Hardpan E] <br /> Previous Application Made: Yes E] No M_ New Construction: Yes �l\lo 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> a r <br /> Septic Tank: Distance from nearest well__ _j'30------Distance from f9undaf ion------.TtP-------Material-__ ---------- <br /> ZL. No. of compartments.-------- -----------Size.......6,P-----------------Liquid depth._......�6----------Capacity--2494-0------ <br /> Disposal Field: Distance from nearest Distajnce from foundation______! _.Djsfance to nearest lot line----14-d-1 <br /> Number of lines_-_.___1- ;.121.-Length of each line-----------'7.5­4---VWidth of french----- -------------- <br /> Type of filter material__tg.-----5-(Z-Depth of filter material-----_-1,g......Total length___..-- Z)---------------------- <br /> Seepage Pit: Distance to nearest well.- _/1%0-1___._Distance from foundation----*,42—D.(--.Distance to nearest lot line----- <br /> 1%-z4-___Size: Diameter- Depth----- <br /> Number of pits.__._._"________.Lining material. --A - ------------ <br /> Cesspool: Distance from nearest well---------- ---.--Distance from foundation--------------------Lining material-------------------------------------- <br /> El Size: Diameter--------------------------------------Depth--------------------------------- - ----------------Liquid Capacity-.----------------------_-gals. <br /> Privy: Distance from nearest well----------------------------------------------- -Distance from nearest building_____--_---__._._______________ <br /> ❑ <br /> uilding-------------------------------El Distance to nearest lot lire----------------------------------------------------------------_---- ------------------- -------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------- ---------------------------- ------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------__----------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count <br /> ordinances, <br /> State 1, 5s, and rules, and regulations of the San Joaquin Local Health District. <br /> (Signed) <br /> . . ...... .... . ..... . ... -----------------------------------------------(Owner and/or Contractor) <br /> -------- <br /> By. <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--------- - ------------------ ...... ----- ----------------------------------------------- DATE."." lc�r---------------------------------------------- <br /> REVIEWEDBY-------------------------------- ----------------------- ---- ------------------------------------------------------------- DATE--------• ----I IS I---- ----------------------- <br /> BUILDING PERMIT ISSUED------------------------------------- .... - ----------------------------------------------------- DATE_ -------------- <br /> - ------------------------------- <br /> Alterations and/or recommendations:-------------------------- - --- ---------------- ---------- ------------------------------------------------ & <br /> -1N <br /> ---- ---------------------------------- <br /> ----------- ------------------- ------- ---------------------------- ------------ --------------------------------------------------------------------------------------------< <br /> ----- --- ------------------ <br /> --------------------------------------------------------- -- ---------- - ------ --------------------------------------------------------------------- ------------------------------------------------------------------- <br /> -------------------­ --------- ------------------------------- -- ------------------------------- --------------------------- --------- --------I----------------------------- ---------------------------------- <br /> -------------------- -------------------------- ---- C--- ---------_------------------------------ --------------------------------------- ------------ ---------------------- --------------------- <br /> FINAL INSPECTION --- ------------------- ----- Date........... <br /> .... ---- ------------------- ------_---------------------- ------------- <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 /> E5­9 145446 ATWOCO <br />