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APPLICATION FOR SANITATION PERMIT Permit No. ..�3�.la.-_..__ <br /> (Complete in Duplicate) <br /> Date Issued <br /> �,Applica+ioniserUQmade 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 LOCATI N. _-'ate_= �- ----- '_cam <br /> Owner's Name........... --------------------- Phone-------- ....-------•-•-..__,. <br /> Address. 4----. --------.....:......'......'-L-,•—%----------------------------------------------•- <br /> _Contractor's Name_________________ PhonedGP <br /> Installation will serve: Residence U3, "Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___L Number of bedrooms .11'Number of baths ---I__ Lot size .._, .......'-r-Q.. <br /> Water Supply: Public system ❑ Community system ❑ Private 2 1 epth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0'"}-iardpan ❑ <br /> Previous Application Made: Yes ❑ No [f'-'New Construction: Yes ❑ No ❑�� ," <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> o septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 99pti T —"'IIRtance from nearest well-----------------Distance from foundation....................Material--------------------------....................... <br /> No. of compartments--------------------------Size--------------------------------Liquid depth--- ----------------------Capacity----------------------- <br /> zt�F*� <br /> istance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Number oflines_____________________--_.-_---____Length of each line__________--_._._-_-_.___---_.Width of trench......._.._.___.__.._......_...._.. <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length.......................................... <br /> it: Distance to neares welllll. -_Distance from foundation' Q._e__.Dista c to nearest <br /> SeepvNumber of pits. --------------Lining materiae--___--..Size: Diameterj-.3-' ------Depth__-". _-o-- W <br /> Cesspool: Distance from nearest well-----------------Distance fro foundation-------------------.Lining material--------------- ---------------.-___-_. <br /> ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------_Liquid Capacity............................gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------__-__--_•.-.-. <br /> ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------- -----------------_--- <br /> Remodeling and/or repairing (describe) ----------------------------............................................................................................................................. <br /> ----------------------------------•----•----•-•---...----•-----------•----------•--------------------------•-----•-------••--•--.....---•---•-----------------•----...---•---------•--------•-------------.................. <br /> ----------------- --------------- --------------•---. --•------------•-•---------•--......----•------ --------------------•------------------------•----------------------•-...------------------•----•---._..... <br /> 1 ereby c rtify tha I have prepared is application and th_att.the-watt,_will be done in accordance with San.Joaquin County <br /> ordinances, S#a laws, an rules and regul ions of the San aaquin Local Health District. <br /> (Signed)-------•---- -- -------- - ----------- ------ --------- -• --- ---- ---------------------•-------------- ------ ntracfor) <br /> By:-----------------------------------•--------------------------- -- - ------- ------------------- ,------------(Titl -_----- -- ------- --------------....... <br /> (Plot plan, showing size of lot, location of sy dem in elation to wells, 'dings, etc., can be laced on reverse side). <br /> FOR DEPARTMENT USE ONLY f <br /> APPLICATION ACCEPTED BY---- •------•--------------- DATE------.�-----•---------------•---------------°--•---. <br /> REVIEWED BY-_-------------------------------- ---------------- DATE-------- �-� <br /> •--•------------------- <br /> BUILDINGPERMIT ISSUED................................ ---- -----------------•--------------------------------------- DATE................ �------ •-------- <br /> Alterations and/or recommendations_________________________ S <br /> ------------------------------------------------------------ ------------------------------------------------- ---------------------------------------------------------•-----•--- <br /> -------------------------------------------------------------------•----- ---------------------•-------------------------------------------------°-------•--------------------------.-.-. -------------------------•--- <br /> FINAL INSPECTION BY:`/L ----------------- Date.el._-----------------------------------------------------b� <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 /> ES-9-2M 145446 ATWOOD 12-54 <br />