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APPLICATION "FOR SANITATION PERMIT Permit No. ... 3 <br /> (Complete in Duplicate) / ~- <br /> Date Issued <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 /> JOB ADDRESS AND LOCATION...,..-1-4i IF..--. ----- '.---5----------------------•---------------------------------=-------------- <br /> Owner's Name--- ------ ---------------� ------------------I----------- ------------------------ Phone-44--?� ... <br /> Address---- ----------- 'i- ---------------------------------------------------------- -----------------------------------------------------_------ <br /> Contractor's Name.. '1�b -- ---lt`-•irj �T it ......-----_--------------------•-.-•--- •-------•--- Phon .--�-7Q�/C 6 <br /> Installation will serve: Residence EgApartment House ❑ Commercial ❑ Trailer Court ❑ , Motel ❑ Other ❑ <br /> :. Number of living units: ---4- Number of bedrooms ___`K Number of baths __f':: Lot size __ji2__"'_.X____/_1_ .. <br /> ------•-- <br /> Water Supply: Public system 2-11community system ❑ Private ❑ Depth to Water Table j7pft. <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 V�'—New Construction: Yes ❑ No ❑ <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 well Oh .Distance Brom four(dation_9_ _._..Materia`____ --------- <br /> No. of compartments__.I- _"'_______________Size_ __ __ A__,2�L____.___Liquid deppth_4. Capacity..�'_®0--J � <br /> Disposal Field: Distance from nearest well--- "._Distance Trom toundationZ_ ___.;-.Distance to nearest lot --- <br /> EiK <br /> Number of lines-----!= __ Length of -- o� Width of trench.�lfz-------___._--.-_- <br /> Type or filter material__._ __`._____ Depth er m eri I----- length_ ....... ..................... <br /> .s <br /> Seepage Pit: Distance to nearest well__ _ ..17�l - ____Dist c ram foun at n_._ ....___.Distance to nearest lot line____._____ <br /> Number of pits.--.--/--------------Lining mat r al __i.:_...Si e: Diameter___ P___ ._._Dept h__saZ_. '.._.__.___ <br /> Cesspool: Distance from nearest well-----------------Di Lance from foun tion---------------------Lining material__._-__-._-__--_-_--____.-_--_-___- <br /> Size Diameter-__.--._--._-_.-_:_________________De th___.-.-________._ __._,-_Liquid Capacity-. gals. <br /> Privy: Distance from nearest v✓ell_...___..-_____....__.__ __._______._ _______Distance from nearest building----------.____________: ':_ ____._. • <br /> ❑ Distance to nearest lot line-----------------------------_--------- <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 Joaquip-Gaunfy <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> _ DAY&NIGHT <br /> (Signed) <br /> ------..... a •---- ------- . or Contractor <br /> 1206 So_,Eidorad®--HO 2-7046 ) <br /> BY: -.---....(Title) <br /> (Plot plan, sho size of lot, Io�Rfii?"of q9 A�m in relation to ells, buildings, c., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- --------------- --- ---- ---------- ------------------------------------------ DATE-- - ------------ ---------------------------------- <br /> REVIEWEDBY------------------------------------------- --------~­-- --- -------------- ------------------------------------------- DATE----- ---- �c, --- <br /> BUILDING PERMIT ISSUED------------------------------------- -- DATE--- ------- - -%: ~'--- -------- <br /> -------------------- <br /> ----- -- -- <br /> - ------------------------ �7"�. <br /> Alterations and/or recommendations----------------------- ----- 1-- 1j <br /> --- — i ---------------------- ------------------------------------------------------ <br /> --------•----------------------Q------------------------------------------------ -------- --------•-------•-•---------------------------------•---------- -----------..-------- -------------------------------- <br /> -------------- �.�. <br /> FINAL INSPECTION BY:. 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 /> ES-9 145446 ATWOOD <br />