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�, ��► f APPLICATION FOR SANITATION PERMIT Permit No. _ !9 <br /> (Complete in Duplicate) / <br /> Date Issued <br /> AlPP lica{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 IOCATION------ - <br /> ----- -------- ----q=---------- <br /> --------------------------------------------------------- <br /> Owner's Named L� � /P� IG� •�-------- f._ 9�{{� '�/. C_�1 t•(. ,r,{ nc <br /> Address__________ <br /> e L' h'k 'f' - <br /> ---------------------- -------------------------------------------------------------------- <br /> Contractor's Name------ ` -"-� - Phone <br /> Installation will serve: ResidenceaL�_.Apartment House ❑ Commercial [� Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ------.- Number of bedrooms -------- Number of baths _ Lot size __:_4-----L- ---- - ---------y-_________ <br /> Water Supply: Public system .Community system ❑ Private ❑ Depth to Water Tabl,e ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,& Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 23-- New Construction: Yes R No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available withifi 200 feet.) , <br /> Septic Tank: Distance from nearest well-A/611 -stance from foundation__/1�,..,--------Material----- -------------- <br /> �.. No. of compartments----- ---------------Size.... --A Liquid depth__,5__r4,,_.------._Capacity-_-___�O�)..__- <br /> Disposal Field: Distance from nearest well.._/_4/'0_?'L4istance from foundation----- Q,........Distance to nearest lot line.._.'_-____-__ <br /> [ Number of lines-------,/----_ . Length of each line------- .__..Width of trench-_-__ -------------------- <br /> f <br /> Type of filter material-_/__p- 5-R-Dep'ih of filter material Total length____:s __ -------------------------- <br /> Seepage Pit: Distance to nearest well__ ----D`istance from fpundation____� _`____.Distance toy,nearest lot line._.__________ <br /> P_ Number of pits.... ----------------Lining' material_'C4--/-g,-).g, Diameter.__0.43. Dept ------__ �\4 <br /> Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material---------------_--------------------- <br /> ElSize: Diameter----------------------=---------------Depth------- ------Liquid Capacity------------------------._.gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-_______________________________-___-- <br /> ❑ Distance to nearest lot lint:------------------------- --------- -----------••--------------------- ---------------------------------------------• ---•--------------- <br /> %1)Pmodeling and/or repairing (clescribe):---- ___----------------------------------........ ----- <br /> ------ --- - ------------------------ --- ---------------- - 1 <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, States, and rules and regulations of the San Joaquin Local Health District. <br /> E X2`2` ----- ------------------------------------------------------------(Owner and/or Contractor) <br /> (Signed) <br /> e==, <br /> By:._ --� z — r (Title) z-� - <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------------- �e-`. --------------------------------- <br /> ?EVIEWED BY---------------------------------------- ----------------------------------------------------------------- DATE y <br /> IILDINGPERMIT ISSUED---- ------ = ---------------------------------------------------------------- DATE--------T----------------------------------- -------------- <br /> �rations and/or recommendations: ---------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------- ----------•----------------------- ----- -- <br /> ----------------------- ---------- ---------------------- ---------- ----------- ------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------- <br /> --- - <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL <br /> -----------------------------FINAL INSPECTION BY:- --- f -- ----­--------------- Date----- --------------` ----------------------- <br /> SAN <br /> ------ ---- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES J 145446 ATWOOD <br />