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p\01 APPLICATION FOR SANITATION PERMIT Permit No. ; R <br /> 1 ( ' <br /> (Complete in Duplicate) l4 Xt"' <br /> P P // ,. <br /> r" i, � �_eDate Issued ----- <br /> r. Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. .t, <br /> This application is made in compliance with County Ordinance No. 5 9. <br /> JOB ADDRESS AND LOCATI N_._.. _- �.®..�d". ---- -- <br /> Owner's Name------ L� .' f -�Z41'L = Phone <br /> Address------..e �!" � �-- . ... = <br /> w 1 <br /> Contractor's Name---- -------------- --------- ------ -------------------------------------------•--------------- Phone <br /> Installation will serve: Residence �rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> F Number of living units _ __,Number of bedrooms .-.�V Number of baths ..L-_. f size _.. .-Qom.-.. _-« _-----.--. <br /> Water Supply: Public system ❑ Community system fijL-Private ❑ Depth to Water Table 440 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 [ New Construction: Yes T 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_./ . e--Distance from foundation.-./z,. .._..Material--. ---------- <br /> No. <br /> ..- ---No. of compartments------- --------- -----Size------,..�7� 3e-3_6_i uid de th_______ . _.. Capacity -;01 ------ <br /> Distance <br /> 4. Disposal Field: Distance from nearest well-_f -r.Distance from foundation------ - ------Distance to nearest-lot line.. ©----_. <br /> ,,,2-- r� -Length of each line......- -�.-..Width of trench.... _______________._ <br /> 91 �, Number of lines...._._..' " -. <br /> Type of filter material._ Depth of filter maferial..../._$-----------Total length-.--.- --- -_-_............... <br /> t Seepage Pit: Distance to nearest well_/ -----..Distance fro foundation___ . ._._..Distance to nearest lot line..., <br /> i ._ter.�.. <br /> ] Number of pits_---,�� ---------Lining material. .. i Diameter,__.. _�-.....Deptn-----_, �_..-------/ <br /> 4 Cesspool: Distance from nearest well-----------------Distance from foundation-------- Lining material-------------------.------------._.-. <br /> -4 `' �4❑y 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 /> F <br /> _ »................................................_-..._--•..__-•-•...._.----------------------.... <br /> ... .........------------...........----------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------- --------- <br /> I hereby certify thail have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State Iwf. a rules and regulations of the San Joaquin Local Health District. . . <br /> (Signe --- ----- -- --------�--- ' ---------------------(Owner and/or Contractor) <br /> _.: _ $y -----------------(TitI e)------ - -------------------------------- <br /> --�--- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> � r <br /> APPLICATION ACCEPTED BY DATE �l --------- <br /> REVIEWEDBY------------------------------------------------- -- --------------- ----- - -------------------------------------- DATE --------------•Z---------- -- -------------------- <br /> BUILDINGPERMIT"ISSUED.--------------------------------- --- -- -------------••---------------------------------------- DATE--- --------------- %---- -------------------------- _ <br /> Alterations and/or recommendations:- ------------------------- ~ <br /> ---•------- --- -• ----•------------ _.. '- --•---------------- <br /> :. --- -- - ------ <br /> ---------- s�, ------ ..... 1to <br /> ----------------------- <br /> _u ----------------------------- ------- --------------------------------------------------------------------- i <br /> FINAL• INSPECTION BY: = -----• Date... _..Q.- -J --------------------------------- <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 /> 3- E5-9 145445 ATWOOD f <br />