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APPLICATION FOR SANITATION PERMIT Permit No. --- G-°-- ...____ <br /> (Complete in Duplicate) I 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 Count Ordinance No. 549. •� ,� � ld <br /> 3 Yf D 1f-{r CccJ r.2 - <br /> JOB ADDRESS AND LO ATI N..-- h --� --­­1...... � . <br /> . ----- -- -- <br /> Owner s Na e '= `'" ! "`a ------------- - --------- Phone. <br /> Address = ----- -----�-e�------ ' �. d ------•---•-•1--------------------------------------------------•---------------------------- <br /> Contractor's Name .. i �E E�ff :=--------�- .----- Phone----•----•------------------------- I <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ <br /> Number of living units: �"' Number of bedrooms.- Number of baths -_ Lot size t .:�--- 1- <br /> f <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 87- ft. <br /> Character of soil to a depth of 3 feet: SandGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I] Hardpan ❑ k <br /> Previous Application Made: Yes ❑ No E�, New Construction: Yes �lo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank:-'l Distance from nearest.,w.{ -� 'Distanc f om fo nd tion. - --Mtrial - -- -- ` '� <br /> --- <br /> <`- No—Z4 compartments----- - r' Size-- Liquid depth--. -----. Capacity---- <br /> Disposal Fiel Distance from neares well__-f-P-_--.-Distance from fou dafiop-__ .� �- Distance to nearest lot line--- 49-`. <br /> Number of lines__- --------------------- Length of each lis _: - .-� 7' iNidth of trench.--. <br /> er -- <br /> -------------•------ <br /> Type or filter material .--_--- epth of filter materEal--.. __._---Total length------i �--------------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from'foundation-.-.--_-- _--.--.Distance to nearest lot line------------------ Ck� <br /> ❑ Number of pits----------------------Lining material---------------------- Size: Diameter------ --- Depth----------------------••--------- M, <br /> Cesspool: Distance from nearest well-----------------Distance from foundation..-_- {___''Lining material-----._-----------------.__----------. <br /> ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------LiquidCapacity-.--•--------------------•--gals. <br /> Privy: Distance from nearest well.................._-------.-------_-------..----Distance from nearest building------------------------------------------ <br /> Distance <br /> - __----_---------.--_-_--.-----.-----Distance to nearest lot line--------------------------------------------------•---------------....... <br /> Remodeling and/or repairing (describe) s'r --------------------------•-••----------•---•---- <br /> - ------------­----------•-•-------- ----- - <br /> r ----------------�..----• ------< --- <br /> % <br /> '-' ---•--. • --Q----------- -- ` ------ <br /> - - -- -- -- -- <br /> ' �. - --------- r< a ------------------------------------- ------ °i <br /> I hereby certify that I have-prepared this application and that the work will be done'in accordance with San Joaquin County <br /> F ordinances, State laws, and rules and regulatf ns of the San Joaquin Local Health District. <br /> 0 -----•�-- <br /> (Signed)............. .... '- (Owner and/or Contractor) <br /> _ - B . -- <br /> ......•-•-• . <br /> (Title) /�,�------ - G1 -- <br /> Plot Ian, showingsize of lot, locati, of system in relation to_w"ells,;buildin. s etc.,rcan..be_ laced-on-reverse-sid <br /> FOR DEPARTMENT.USE ONLY <br /> APPLICATION ACCEPTED BY----- --------------- - -- - -- -- ------------------7--------------------------------------- DATE-------- <br /> REVIEWEDBY----- ------------------------------ -------- ----- --- -------------------------------------------------------•-------- DATE------------ <br /> ------------- <br /> BUILDING PERMIT ISSUED----------------------------- DATE.------------ ----- �--- ---..---------------------- <br /> --- <br /> . -----------••----- 3 <br /> Alterations and/or recommendations--------------- ------------ --•_-•- <br /> -- <br /> -------. --•--•- --•-------•----------------•------••-•------------•--------------------- ----------------- ------------------------•------- r: ----------------------- <br /> --------------------- <br /> ---------•-•-••----------•------•----- ------------•- ---------------------------------------- - - -------------------------------------------- ------- ---••------- ----------••--••-•-----••-- <br /> --------------•--------- -------------- ----------•----------------------------.- ----- -•----------- -----------------------------------------• --•--------------------- <br /> ------------------------------------------------------------- ..----- <br /> 4 <br /> •--- Date...... ..- . I <br /> FINAL INSPECTION BY:.. .-- - ---•-------- I . <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 /> E5�7 145446 ATWOOD <br /> . a <br />