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��� V <br /> `.> APPLICATION FOR SANITATION PERMIT Permit No. .....7_Q_�j,_f1_ <br /> Q� (Complete in Duplicate) G Sr <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 /> t -- <br /> JOB ADDRESS AND LOCATION------`/,/ 1 .........�P_5..S.e..........`'----f=----------------------------------------------------- <br /> Owner's Name `S' ...........................................---------------------­-- ----- Phone---------------------•-=----------- <br /> Address•.•-..-_•��--_-'2t?? ................................................=.............................................................................. -----------••---•----------•- <br /> Contractor's Name-------P57f'.R1.S N_._..Zs"_< - ----------- ..........------------------------------------------------------ Phone................................... <br /> Installation will serve: Residence [ 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___!(_. Number of bedrooms _____/. Number of baths ___Z_ Lot size _________________________________ <br /> Water Supply: Public system ❑ Community system ❑ Private [&--Depth to Water Table,5_0 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 [j L.,- •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. Distance from foundation----O_,f_-______Material __ _,eQ i-�•C <br /> No. of com artments__-- .� <br /> p Size- -- `�_f_ _�_��_Liquid depth -----6- -`�--------_Capacity_- !�0 <br /> � <br /> Disposal Field: Distance from nearest well--7,.:5_____--_Distance from foundation__,-7,J__t._-Distance to nearest lot line......9A.1 Number of lines............�____r__T,---------Length of each line....... A�f __:_-Width of trench ` -------- <br /> Type of filter materia3_-X,_Depth of filter material___ /_8`"._Total length___.---l A_-------�31Q....... <br /> Seepage Pit: Distance to nearest well -lQ_a_f_____Distance from foundation....z2O ._.Distance to nearest lot line � <br /> [S Number of pits-------./:___._. _-Lining materiaL_eA'.1fAC_-Size: Diameter_- x'- _":_..:Depth,__._ ) <br /> Cesspool: Distance from nearest well______________ __Distance from foundation___-_--------------------Lining material------------------- <br /> Size: <br /> ____-__. _-.Size: Diameter--------------------------------------Depth--- ______-___-__ __ ____ ___-Liquid Capacity gals. <br /> Privy: Distance from nearest well.------------- Distance from nearest-build ing----- <br /> _ ------ � <br /> ❑ Distance to nearest lot line-------------------------------- ---•----- ------------------ -------- -------- ----,--- -•--- -. .-- ----- <br /> Remodeling and/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, Sta laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)__.______ _._C7,11 / .A7--_._ ,,., ___ .�___'_ wner and/or Contractor) <br /> -- ------ - ------------------------------ ----- ------- <br /> r <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 /> APPLICATION ACCEPTED BY--- -- ----- --------- -- ---- -- --------------------------------------•----------- DATE---------4CP - <br /> REVIEWED BY-------------------------------------------------- ------- ----------------- E \ <br /> ------------------------------------------ DAT _-----------_. -..-------................................ <br /> BUILDING PERMIT ISSUED.....................•.•---•--------- - ----•--•------------------------ <br /> - •--• DATE ..j <br /> \ h -- -------- �} <br /> Alterations and/or recommendations -- - "'V - -•- ------------•-=-----•.. ---------•--••--•--•-------•-----�....... <br /> -�5 ----------------------- <br /> ------------------------------------------- <br /> -------- ------- <br /> =: <br /> --------- --------------------- .:--r �-�` , ------ ---------1- - --{� --- ----- <br /> FINAL INSPECTION BY:.__ .: '+-L&----------------------------- Date.......... _-_--- __-/.. <br /> --- -------•--------•---- <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 /> E9-9 145446 ATWOOD <br />