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�'D 3 8 <br /> APPLICATION FOR SANITATION PERMIT Permit No. .................._ <br /> (Complete in Duplicate) %a <br /> Date Issued ---- _z vAszl <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 A ATION. T . -.---- -- ...... ----•--• ----•--- --------- . ------ --•---------------- <br /> Owner's Name....... ..................... -- --•- • . -- .................•----- .---- --- ..................... •-----............. Phone....................................Address __._4.0 -7 -- ---•-•-------•------------•- <br /> Contractor's Name---- .... .......1.It�.......................................................................................... ................... Phone. ....-------------•--------- <br /> Insfallation will serve: Residence,&""Apartmennt House ❑ Commercial ❑ Trailer Court ❑ Mcl ❑ Other ❑' <br /> Number of living units: ...._ umber of bedrooms _-!---- Number of baths ._/..:. Lot size . :4! _ . ... . ................. <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .........ft. <br /> Character of soil to a depth of 3 feed I Sand Gravel ❑ Sandy Loam Clay'Loam E] Clay❑ Adobe Hardpan E]Previous Application'Made: Yes ❑ No New Construction: Yes No <br /> TYPE OF INSTALLATION AND -SPECIFICATIONS: <br /> (No septic tank or cesspool permitted ' ublic or is available within 200 feet)j ��� ;�.�. <br /> Septic .._ _ _nk: Distance from nearest wel Dista fr fo ation ater' <br /> ------------------ <br /> --- <br /> No. of compartments.--•-- ize . _._.._ :_._Li uid. th...: --. <br /> q l P. Capacity_.. _. <br /> Dispos field: Dis#ince from nearest wet__ _ : Distance from foundat�oc rstance to nearest to Ii. ' <br /> Number of lines.. 1 i ! <br /> Rr <br /> Length of each fine Width of trench_ <br /> ----------- <br /> Type of filter materi -` <br /> YP ► _ pth of filter maternal-- --t�- ---------Total ler6gth.............. .---­------­ <br /> Seepage <br /> --- --.Seepage Pit: Distance to nearest:well _____________________Distance' from foundation_____. .__.,Distance`to nearest lot line................. <br /> ❑ Number of pits---- --------- Lining material:------ -------e__.._Sizvf;Diame#er -------•---Depth <br /> "V <br /> Cesspool: Distance from nearest welt.______• _.__Distance from foundatipr�.�,& ---•---------L1nmg materiel_.. Q, <br /> ❑ Size: Diameter. —, <br /> ----------------­----------Depth.....- •................................--------Liquid Capacity------------- •---_--gals. 01-\ <br /> Privy: Distance from nearest well_----------------------------------------------Distance from nearest building--.---------------------------------_----- <br /> ❑ Distance to nearest to#.line ------ •-------................. ---------------------------------I------------------------------------------- <br /> Remodeling <br /> ----- - ------- ---------------Remodeling .and/or repairing-(describe)............................................................................ -------------------------- <br /> - <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, State laws, a rules and regulations of the San Joaquin Local Health District, <br /> (Signed� .. ------------------------- -------(Owner and/or Contractor) <br /> BY ------- -----------------------•-----•-• -------- ------- ------ ---_... ..---- ------- --------(Title)----- -- ----------------- <br /> (Plot plan, showing size,of lot, location of system in relation to wells. buildings, efc.. can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B ---------------------------------------- DATE 7.w, - <br /> REVIEWED BY------------- 19ATE <br /> BUILDING PERMIT ISSUEQ - ----- - <br /> Alterations and/or recomme tons:.. (t� <br /> / ����� ---•-•- ----- ----- ........-`����.�.-►E'er. <br /> ._. _ .. .. _.. -- <br /> -------- -•--- ----- ------ <br /> ----- <br /> r � /, <br /> FINAL INSPECTION BY:--- �_ .................................. Date ,.✓-.: .....-- ` <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Streat 300 Wast Oak Strait 132 Sycamore Street 614 North "C" Street <br /> Stockton, California Lodi, Caiiforaio Manteca, California Tracy, California <br /> ES--9-2M 145446 ATWOOD 12-54 <br />