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APPLICATION FOR SANITATION PERMIT Permit No. ._. ..� . <br /> (Complete in Duplicate) 'I p <br /> Date Issued ......./', . ..5 <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct Tjdi,.ns4tI t work hereir�descri*. <br /> Thisapplication is made in complian with County rdinance No. 549. r;JOB ADDRESS AN LOC*TIc 1 ��` ' f ---••- - ------ -------- ------ <br /> Owner'! Na �` t t "'--rJ _------------------------- -----------------------------------------5Phone.................................... <br /> .. ... <br /> Address........ ` ` = ` ' ,,o �. <br /> Contractor's Name ................... ... Phone.----.....-••-•---•-------•-•--••-. <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other, ❑ <br /> Number of living units: ---1--- Number of bedrooms __& Number of baths ..1.... Lot size <br /> Water Supply: Public system E] Community system ❑ Private <br /> AA-UL <br /> to Water Table ._...._ ft. <br /> Character of soil to a depth of 3 feet: Sand [:] Gravel E] Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hard <br /> Previous Application Made: Yes ❑ No e New Construction: Yes Q(NO'E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pubtic sewen is available within 200 feef.) <br /> Septic ank: Distance from nearest welloe� � ��istan from fou ption `!?�'v_Mate,rif I�./- =� <br /> x9� � <br /> No. of compartments-------- * --------Siz ____. Af" ty .. _ <br /> P - -�- -•----Liquid epth--,-,-e--- - ------- CaPmci <br /> Dispos Field: Distance from nearest el. .o,�..illistance from foundation.1 .�'_--•_:'Distance to nearest loft line <br /> Number of lines______.. - ` ----_--. _._Length of each line___ __ t�............... . <br /> - ------ � p C+S�� �---.Width of trench---------••-��"--�" <br /> Type of filter mater• t: rr j <br /> � e th of filter material___-..�.. _�.-____._.Total length--------- ................... <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of pits--..------------------Lining material----------------------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 /> Remodeling and/or repairing (describe)---------- ----- ----- - ------------------------------------------------------------------------------ .-.- ................ }- <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> � r <br /> (Signed) ��' ----- P <br /> ._.�'.:. ._:_ "�-------------------------------------------------- ---------------- -------(Owner and/or Contractor) , <br /> By:..................................................................................... ------------------- -------- .......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 /> APPLICATIONACCEPTED BY -------------------------- ----------..-..-----•----------------------- ------ DATE,-�-------------------------------------------------- <br /> REVIEWEDBY•--------_-------- - ------------------------------------------------------------------------------------- DATE_- ....................................................... <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------•-----------------•--------------------- DATE----�-------------------------------------------•-r <br /> Alterations and/or recommendations------------------------ ---•-----------------------------------------------------------------------------1�i7-............... <br /> ..................................-----------------------------------------------------------------------------------------------------------------------------------------------------------............................... L <br /> ---------------------------•----------------------._......------------. ------- --------------- --------------------------------------- --------------------------------------------•------......--•••------•-•-•-••--••••... <br /> ---------------------•----------------------------------..--------------- -----------------_-------------------------------------------------------------.._-------------------------------................................ <br /> ------------------------------------ ------- ------------------ <br /> ------- -----------------------------------------------------------------------------------------------------------------•---------------------------•-------- <br /> FINAL INSPECTION BY:.. = -------------------------- Date-l.1R---`� <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 /> ES-9-2M 145446 ATWOOD 12-54 <br />