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APPLICATION FOR SANITATION PERMIT :Permit No. _._ __� <br /> 41 (Complete in Duplicate) , <br /> I 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 <br /> LOCATION_ ._ ----- _ -------- -Phone.---------•-- <br /> Owner's Name_ <br /> Address ---------- � s.jo------- <br /> Contractor's Name-- ...... -� �" -' Phone <br /> � -''" ------------•---- <br /> Installation will serve: Residence ice-- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _A' Number of bedrooms --%a. Number of baths __4?7:7 Lot size ---_-$_a-__�...!.R_5 — <br /> r-- <br /> Water Supply: Public system [E_ ommunity system ❑ Private [Depth to Water Table 4;L<ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q?,, Hardpan ❑ <br /> Previous Application Made: Yes ❑ No W New Construction: Yes 0, 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.../0V......Distance from foundation---l_6_.R_.____.Material___(f_4-_ �C <br /> 9KNo. of compartments_-___._,.' -------------Size. ..__Liquid depth----- Q_________Capacity <br /> Disposal Field: Distance from nearest well----/M-/Distance from foundation__.17.........Distance to nearest lot line.._.: p__/. <br /> [L� Number of lines------------ _ Length of each line__.___-0__'._ _...Width of trench______ f _�-___________ <br /> Type of filter material____ lT.W. _!Depth of filter material_______ ----------Total length_____s 4__--_____________________ <br /> Seepage Pit: Distance to nearest well___�_lT _�_ Distance from fojjndation__,,o.f__._._.Dist nch to nearest lot line..__,, <br /> ❑� Number of pits___-_-/_-_-_______Lining material. 4ize: Diameter—:575:___.___-Depth-------��.__________ 9, <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 /> ElDistance to nearest lot line---------------------------------------------------------------------------------------•-----------•-------•------------•-••--... •-------- <br /> Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------•-------•-------------•-----------------••-••-•-- <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, Ste ws, and rules and regulations of the San Joaquin Local Health District. <br /> --- - -------- -----------------------_-- -__-----------------------.__ Ow er and or Contractor <br /> (Signed)... . ( / ) <br /> By ----(Title)-- ------- <br /> (Plot pla , sowing 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------------ �­____, <br /> ------------------------------------------------------- DATE---•-�.............................................. <br /> REVIEWED BY..... DATE —-•_____•-----------------•------------ <br /> ---------- ------ --------------------------------------- <br /> BUILDINGPERMIT ISSUED............---•----------- ---- ------ --------------------------------••-----••-•-• DATE............ <br /> Alterations and/or recommendations------------------ ------ - ------------------------------------------------------------------------------------ ------_--b - - - <br /> ---------- \ ---- I <br /> �.! <br /> ------------------- ___------------ <br /> _t------ ---------- <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 />