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Permit No. --- - .. 5.....y APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued ...VM f s <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 in compliance with County Ordinance No. 549. <br /> _ � ' -------------------------------------------------------•------- <br /> JOB ADDRESS AND LOCATIO <br /> ------ ------ - <br /> Owner's Name------6QW----•- • - -------------------------------------------- ---- - <br /> -------------------------------- Phone <br /> Address ..d . ----- --------------------------------------------•---------------•------- <br /> Contractor's Name----------- ---------------- Phone - ...- - _ <br /> Installation will serve: Residence P'partment House [I Commercial ❑ Trailer Court ❑ Motel Other <br /> Number <br /> ❑ <br /> Number of living units: ---/--- Number of bedrooms _� Number of baths _/.-- Lot size -_-_- 4-_--- --J-------------- <br /> Wafer Supply: Public system X Community system E] Private E] Depth to Water Table_10_i ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No W----New Construction: Yes to ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> _- -- ----.MateC -- <br /> --.�_.- <br /> --- <br /> Distance from. nearest well--_Distance fr9m four, a- � � <br /> SeptYNo. of compartments-__ -------Size-✓ _ -------Liquiept ... ----------- Capaci , <br /> Disposal d: Distance from nearest well' Distance from foundation--�.-A------.Distance to nearest lot line----------------- <br /> Length of each line------_ -_ .Width of french------ -R--------------•-- <br /> _ Number of lines-------1------------- ---- - -�- ---_-�i- A <br /> I Type of filter material-�� ---Depth tial Total length 4r�Q <br /> See it: Distance to nearest well---- ---- ------------Dis#(nz from oun ion-...-L/Q_-_.--.Distance to nearest lot line----,A ---- 6G : Diameter ` Dep#hNumber of pits--.---/.-----__---Lining mater _---�-- --------- <br /> Distance from nearest well------------------ ation-:--___-----.,_.---.Lining material-.--------.-.------ <br /> ❑ Size: Diameter--- -------------------- -Depth----------------------------------------------------Liquid Capacity-------------------•--------gals. <br /> t Privy: Distance from nearest well----------------------------------------------_-Distance from nearest building--------------------------.--------------- Ir <br /> ElDistanceto in lot line----------------------------- --------------------------- --------------------------------------------------- <br /> Remodeling and/or repairing (describe)--- ------------------------------------------ --------------------------•------------------------- ---------------••--------------------------- <br /> ------------------------------------- ----------------------------­----------- <br /> --------------•-------------------------------•--------...-------------------------------------------• --------------: --------------•--------••------ ----------•----------------------•-------------••-------------------------------------- <br /> ----- --------•-----•------------------------------------------•-------------•------------•-------•---------------------------- ----------------•----------------------------------------••-•------------------------ <br /> I hereby certify that I h ye prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, a aws, an u[6s an reguI .t ons of the San Joaquin Local Health District. <br /> -- ------------------ ---------------------------- <br /> °------------- Contractor) <br /> By:--------------- - --- <br /> - - -- ------ - - -- ----------------- - - <br /> --------------------------------------(Title] <br /> (Plot plan, showing size of lot, location of ystem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- ------------------------------------------- DATE------ ---------- --------------------- <br /> -- --------- <br /> --------------------- ----- ----- ----------------- -- ------ -�--------------------•--------- <br /> j REVIEWED SY--------------------------------------- - -- - - DATE --------- <br /> BUILDINGPERMIT ISSUED-------------------------------------- - -- -------------- ------------- DATE..--------------------------------------------------------- <br /> Alterafions and/or recommendations------------------- -- -------•-------••---•--------------•-•-•I----•-•-----------•----------- <br /> •-------------------•------- <br /> .---------•--------•------•--- •------------------------- <br /> yF .Ss --------------------------- <br /> FINAL INSPECTION BY:...... <br /> - ------------- 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 /> E S-^'9-2M 145446 ATWOOD IZ-54 <br />