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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) ryf' f J <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• 49 <br /> �OB ADDRESS AND. LOCATION : -' t`1 <br /> --------- - --------------- <br /> Owner's Name--_._ "- •" <br /> . �_Xl - - - -----•-----------•-•-- <br /> -- ----- --•---- •--- - ----•- ------------•-----•--- ------------------------------- -------- Phone.----------•-------- <br /> --"-----------===-- ------ - <br /> Adress-----------------------•--- L. ---------------- <br /> Contractor's Name---- - . <br /> *----Re 0----&--- -­----,-------*--------------------------------** - ---------------------•- <br /> -.- Phone, .S.l._ <br /> Installation will serve: Residence <br /> par meat House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �r <br /> Number of living units: ---/--- Number of bedrooms --.Number of baths ./-."_ Lot size _/0,4 <br /> Wafer Supply: Public system ❑ Community system ❑ Private 26-117e'pth to Water Table __e__ ft..,�-, <br /> Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam C) Clay Loam ❑ Clay ❑ .Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑} No &--1dew Construction: Yes 6--HU7ffT~" � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> [No septic tank or cesspool permitfed if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest -61-6'0---�_Distance from foundation <br /> K' _ /0._`"".".Mat Tial <br /> e ti �.NoTof�corn <br /> -pa rt --~ `._,_ VF'`�i 4�_ p �.::. ----------------------------- <br /> Pacify <br /> _ d <br /> p - Size:_- x' : Liquid acif <br /> p y-- " <br /> Disposal Field: Distance from nearest well_d"_P------Distance from foundation__"�6_- "_.Distance to nearest lot line_-4—T-t-"_- <br /> [ Number of lines--.-- -_ <br /> .- Length of each line"__>"�j�"4-"...--"""-_".Width of trench_�.,�(-__"-"__"-"___ <br /> Type of filter material----1-- �• ---------- <br /> �.._- -- Depth of filter material-._ e 8._. <br /> Total length0----------------- <br /> Seepage Pit: Distance to nearest well---------------------" <br /> Distance from foundation_"""""".""_""...._".Distance to nearest lot line""-_-"" <br /> ❑ Number of pifis. ; Lining material- ---.Size: Diameter----------------- ---Depth--- ------------------------ <br /> Cesspool: Distance from nearest well-------------- from foundation--------------------Lining material❑ Size: Diameter-------------- ------------------------Depth------ -------- ----------------- ._-- <br /> Privy: Distance from nearest well-"- Liquid Capacity- _----- ------------- al'- <br /> _-.--- -Distance from nearest building <br /> ❑ <br /> Distance to nearest lot line------ <br /> . <br /> --------------------------- <br /> Remodeling and/or repairing fdescribe):--------- --------------------------------------------------------------------- <br /> ----•------••---- <br /> -----------------------------------------------••---- -----•------••---•------•----------------------------•-------- <br /> ------------------------------------------------------------------ <br /> i <br /> ------•------------------------- <br /> ----"-"---------------"-----------------•------------------------------------------•--------- ----------------------------------------- <br /> ------------- <br /> I hereby certify that I have ` <br /> Y y prepared this application and +ha} the work will be done in accordance with San Joaquin <br /> ordinances, State laws, and rules and regulations.of the San Joaquin Local. Healfh District. <br /> ----------- ------------------- -------------------------------- ----- oniot Ian, showin size 6 <br /> of lot, location of system in relation to wells, buildings, etc can beplatd reverse sideFOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------""_-_-".. --------------------- <br /> ----------------------------------- DATE--- --------- ----------------------- <br /> ----------------- <br /> REVIEWED BY -------•---------------------------------------- DATE------ -----�..: =�—.,e <br /> BUILDING PERMIT ISSUED------------------ <br /> --- DATE <br /> -- <br /> A ferations and/or recommendafions:J.. <br /> �� <br /> ---------------------------------- _-------------"------- - <br /> FINAL INSPECTION BY:..-------" "�-- "--- ""-- Date.----_-"-- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street <br /> 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California <br /> Tracy, California <br /> E5-9-2M 145446 ATWOOD 12.54 <br />