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APPLICATION FOR SANITATION PERMIT Permit N --9----5 <br /> ------- <br /> (Complete in Duplicate) �,14 <br /> Date Issued ------ <br /> 0 2--C o--ce-� <br /> Application 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 w Ordinance,�h Cou&TOrdim, e No. 549. <br /> %rS'17t-5 9-711 <br /> JOB ADDRESS AND�PCATIC :=/�__ <br /> Owner's Name -7 ------- ---- ------- .............. Phone----------------------------------- <br /> Address.. <br /> -- ----------- -11 — -- --- ------------------------------------------ -------------------------------------------------------------- <br /> 5� <br /> - --- - ------ ----- ------------------------------.__ <br /> Phone_ --i <br /> ........... <br /> Contractor's Nae---- <br /> Installation will serve: Residence Apartment House 0 Commercial JK_Trailer Court [-] Motel El Other El <br /> Number of lg units:1,Ve- Number of bedrooms -A4(eNumber of Lot size ------ -------X.1L _0________________ <br /> Water <br /> 6-0---------------- <br /> Water Supply: Public system [& Community system 171 Private 0 Depth to Water Table 45Y—ft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam El Clay Loam El Clay El .Adobe R_Hardpan E] <br /> Previous Application Made: Yes Fj No P— New Construction: Yes, 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: Distance from nearest weil-Ah7m—Distance from foundafion,/d,_64_.__,% <br /> ANo. of compartments-----_ - ----------- -----Liquid de --------Capacity------ <br /> Disposal Field: Distance from nearest welf---/.11AW'V—Distance from foundation /.4-/----Distance to nearest lot line-_---- <br /> Number of lines---.----- r--------------Length of each line----- Width of trench.___-_ <br /> ---------------- <br /> Type of filter material---4f-----���Depfh of filter materia - -----------Total, length-___cam � <br /> Seepage Pit: Distance to nearest well---Nd7W,—Distance from fpqriclation---14L1......Distance tp nearest lot line_________________ <br /> QL Number of pits....../--.---_---_--Lining materialDiameter____ -Depth-------�Z ------- <br /> Cesspool: Distance fi-orn nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> ❑ Size; Diameter--------------------------------------Depth------------------------------------------- --_---Liquid Capacity--------------------------gals. <br /> 1, <br /> - <br /> Privy: Distance from nearest well,_---------------------------------------------Distance from nearest building------------------------------------------ <br /> I D Distance to nearest lot line--------_------------------------------------- ------------------------------------------------------------------------------------------- -- <br /> Remodeling and/or repairing (describe):_ __ L- -� .........44,&N�t ------tqa— e- <br /> ------------- --------, <br /> ------'u--a------ _. ................. <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 County <br /> ordinances, St laws, and rules and 'regulations of the San Joaquin Local Health District. <br /> Signed -------------------------------------- (0 /or Contractor) <br /> ( ).... ------45e�_ <br /> By ­- --- - ----- --- -----------(Tif le)------- and <br /> -- --- ---------------- <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-----<' <br /> --- ---- - -- ----------------------------------------------- 4;ZF------------------------------------------------ <br /> - ------------ .... <br /> REVIEWED BY----------------------------------------- -------- DATE----------- <br /> BUILDING PERMIT ISSUED----------------------------------------- DATE---------._.---------------------------------------------------- <br /> Alterations and/or recommendations:__-_-_____________________. V------------------------------------------------I------------------------------: ----------------------------- <br /> A <br /> ------------------------------------------- --- -------- f <br /> --- -- --------------------------------- -------- ---------------- .............--------------- <br /> ---------------- ----- - ----- L <br /> 6 4_14 .................... <br /> ---------------------- ----------- ------- ------- - -------- ------- ------- -- ------ ----- --- --- --------------x-------------------­ <br /> ---------------------------------- - ...... ------------------ ---- <br /> ..... ------------- -- --------------------------------- -- - ------ ------ <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 /> r-q-9-2m 145446 ATWOOD 1Z-54 <br />