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"W <br /> APPLICATION FOR SANITATION PERMIT Permit No.:_.: ... <br /> � 4�_ (Complete in Duplicate) Date Issued �~' �.✓ <br /> _��_____�---- �•;_ry <br /> I/ herein described: <br /> Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work e <br /> This application is made in compliance with ounty Ordinance No. 4 . <br /> JOB ADDRESS AND LOCATION____ <br /> l f -------------------- Phone._. <br /> Owner's Name A ,__J- ...... <br /> • J=— '� --------- -- ------ ---------------------------------------------------------- <br /> Address--- 9 U <br /> Contractor's Name.------ ! - ----------------- f---------------- <br /> Installation will serve: Residence Apartment House Commercial Trailgr Court ❑ Mote! ❑ Other ❑ <br /> _ Number of baths I__�jLot size _ .L ---� <br /> Number of living units: ---- �_ Number of bedrooms �- ; <br /> Water Supply: Public system ❑ Community system [( Private ❑ Depth to Water Table -------- ft. <br /> Sand Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe q Hardpan ❑ <br /> Character of soil to a depth of 3 feet: S ❑ ❑ , <br /> Previous Application Made: Yes ❑ No ix 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 wellolr-G�.t.+-Distance�from foundation Material`!- Ca aci ��.--_ <br /> r <br /> No. of compartments.. cc -------------SizesSQ. •1�liquid depth- p tY <br />` --------- <br /> Disposal Field: Distance from nearest well�l.$�.e•Distance from foundation-_-J__C]..--•"--.Distance to nearest lot line---t3� <br /> r _, h <br /> i Number of lines.-----------/---------- i9th of each line---------` -+ -------------Width of trench-----•'fir------------------.-- <br /> th of filter material_--_._-1. _.__Total length_--.�S------------------- <br /> Type or filter material- �1 <br /> Seepage Pit: Distance to nearest we _ _______ ______ <br /> ,___Distance from foundation ' .Distance to nearest lot line_..__-___-. <br /> �' ------ <br /> Number of pits------/_-------------Lining material--- ize: Diameter____ -_ .�'...___Depth--_ l• <br /> Cesspool: Disfiance from nearest well_________________Dista rice from foundation Lining material__.-__--._--____-.--"__---"-_.------ <br /> ❑ --------------------------------------Depth----- ---------------------------------------- ----Liquid Capacity-------------------- gals. <br /> Size: Diameter <br /> ` , --------------------------Distance from nearest building----------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> Distance <br /> Distance from nearest well_______________________ <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, State laws, and rules and regulations of the an Joaquin Local Health District. <br /> (Signed]_.�� - ---- ----- -- � n <br /> . -�-"" (O�e;r Co tracto <br /> i„ ----- _ .- - <br /> - t.� ,. (Tale]--------- ---- -- <br /> - -- - ----- <br /> sy: Ju.(Plot plan, showing size t, location of system in re tion to wells, buildings, etc., can bap ce on arsese]. <br /> FOR DEPARTMENT USE ONLY <br /> rE--------- <br /> APPLICATION ACCEPTED BY - <br /> ----- ---------- ----------------------------------- <br /> - --- ------- DATE ` <br /> REVIEWEDBY------------------ -------------------------- ------ ------ --------- -- -. r <br /> ------ <br /> BUILDING PERMIT ISSUED---- ------------- ---- <br /> -F DATE <br /> Alterations and/or recommendations:---.--- ------------------- / . = --------- ------- -------------- <br /> -;- - <br /> ----•---- <br /> ------------- - <br /> :`------- <br /> ------- <br /> `ZS -- _... __ <br /> - __ <br /> ----- <br /> --- _ rb4 ---------------- - <br /> FINAL INSPECTION BY:. ------------------------------------ Date <br /> sG <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak S+reef 132 Sycamore Street 814 North "C" Street <br /> Stockton, California <br /> Lodi, California Manteca, California Tracy, California <br /> M ES4_2M 145446 ATWOOD 12-54 <br />