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-1 - - - - 1457 "- <br /> W_ <br /> APPLICATION FOR SANITATION PERMIT Permit No. .................. <br /> (Complete in Duplicate) 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............3---- .... ................... <br /> .................................................................................... <br /> Owner's Name-------------------------------/L -a-2 --- --- -------------------------------------------- Phone.................................... <br /> 7—------------------ ------- <br /> /I <br /> Address.___________ . ........ ................................................................................................................... <br /> Contractor's Name.....................6 ..... e.._..----Q__------------- ........................... .............. Phone................................... <br /> Installation will serve: Residence Apartment House E] Commercial [] Trailer Court [] Motel [] Other [] <br /> Number of living units: __-L Number of bedrooms .../_-_ Number of baths I.... Lot size ..�da_x---/,5-0............................. <br /> Water Supply: Public system,*JEJ, Community system [] Private E] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel F] Sandy Loam F] Clay Loam [] Clay F] AdobeHardpan ❑ <br /> Previous Application Made: Yes E] No fi?1— 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 well5Z41' _Distance from foundojion-----/0---------Material---------------- --------------- <br /> XNo. of compartments----------2—---- -----Si,e---,3 X.7X.nt?-----Liquid clep�h-------�Z!D..........Capacity-------A------------- <br /> Dis(,�C <br /> ps6yField: Distance from nearest well----X"k4_4�istance from foundation-o-/-O,--,-..-Distance to nearest lot line_____________ <br /> Number of lines........... Length of each line---------A ............ .Width of french' \ Type oF -------Depth of filter material-------/9---------Total- - ------------------- <br /> &A, <br /> T filter material- ------------- ength---- _19 n <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------........Distance to nearest lot line___.__-.__.______ <br /> F1 Number of pits______________________Lining material-.---------------------Size: Diameter--___-____.__--________Depth__-______________________________ <br /> Cesspool: <br /> epth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___-_-__-_________-____-____________- "�� <br /> ❑ <br /> aterial-------------------------------------- <br /> ElSize: Diameter----- ------------------- ------------Depth-------------------•;--------- ---------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well---------- ------------------------------------Distance from nearest building_________________________-___-__________: <br /> ❑ <br /> uilding------------------------------------------ <br /> ElDistance to nearest lot line----------------------------------------------------------------------- ---------_-------- -------------------------------------------------- <br /> Remodelingand/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 Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> .......G G-------- --------------------------------------------------------------- ----(Owner and/or Contractor) <br /> 2e. <br /> By:.L............---------------------------------------------------------------------- ---------------------------------------------(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 /> APPLICATION ACCEPTED BY--------------------- ------- ------------ ------------------------------------------- DATE----------- <br /> _ ------- <br /> REVIEWED BY .......... ---------------------_---------� DATE . .. <br /> )(n .. <br /> ..........................V--------­------I-------------------------------------------------..... <br /> BUILDING PERMIT ISSUED --------- <br /> .......................................................................... DATE............................................................. <br /> Alterationsand/or recommendations:---------------------- ............................................................:......................................................*------------------ <br /> ............................................................................................................................................................................................................................. <br /> ---•-•-•------•--•--------••--•---•-•••---•-------------------------------•------•---------------...----------------••-•••--•----•---••-•--•--•-••--•-•-•----••-••---•---•-•••------•-•-••---••----------•-•-•-•-------•-•--- <br /> ------------------------------------------------------------------------------------------------------------------------------*------------------------------­--------------------------------------------------------------*--------------------------------------------------------------------------------------------------------------------­-----­-----------------------------------.-.---.--.---------------------------------------------------- <br /> --------------------- <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-9-2M 145446 ATWOOD 12-54 <br />