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-7,2 <br /> APPLICATION FOR SANITATION PERMIT Permit No. __`:Z ___ <br /> (Complete in Duplicate) SO <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 C,,��o77unty Ordinance No. 549, <br /> JOB ADDRESS AND CATION----_�- __2-----�/1-e/-�----------- ------------------------------------------------------------------------------------------ <br /> Owners Name---- ---- ------ ---------------------­----­--------------------- - ------------------------------- -------- -------------------------------------------- Phone------------------------------------ <br /> Address----------------------------3- J_--�--- � •- ..... <br /> Contractor's Name-------- 51_j - -- <br /> --- ---------------------------------------------------------------------------------•----------- Phone----------------------------------- <br /> Installation will serve: Residence�K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: --� Number of bedrooms __ Number of baths _ _ Lot size ____ 1 <br /> 1 g---- <br /> ------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- 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 ❑ Noo New Construction: Yes K 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 wellJY_*-_L+Q1 Distance from foundation_<C?----------__Material- - -------_ <br /> I No. of compartments------;2---------------$ize-- - -. ----x-�[----Liquid depth_--------------------_---Capacity--•-- _------- --- <br /> Dis�pol�l Field: Distance from nearest well_-h�-tom_Distance from foundation____ (,�_____--.-D stance to nearest lot line____4`�J-____. <br /> h7r� Number of lines___._______._______ ___________Length of each line----1__ -- <br /> ---- ------ of trench_--- �-2 iE <br /> Type of filter material.__ ... I&t!4j71h of filter material--__ -__----- otal length-------1_ zt►__f--------------- <br /> Seepage Pit: Distance to nearest well------_---------------Distance from foundation-------------------.Distance to nearest lot line---__-___________ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------____Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------_-----Distance from foundation------------------- Lining material------------------------------------_ <br /> ❑ Size: Diameter--------------------------------------Depth--------- --- --------------- ----------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well___---------___----------___---------------------Distance from nearest building----.--______---___-__________--_-____--_- <br /> ❑ Distance to nearest lot line----------------------- -------- ---------------------------------------------- -------- -------------------------------------------- <br /> Remodeling and/or repairing {describe):-------------------------------------------------------------------------- ------------••----•-•-----••--•-I-------------•-------------------•-•--- <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 San Joaquin Local Health District. <br /> Si ned ---------Owner and/or Contractor <br /> By—.................................•-- --------------------------------------------------------------------------------------------(Title)-------•- <br /> ------------------------------------------- <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--------- <br /> REVIEWEDBY--------------------------------------------- ------- ----- - --------------------------------------------------------. DATE-------- - <br /> BUILDING PERMIT ISSUED--------------------------- - DATE_ <br /> - S <br /> DATE- -------------------- ..... <br /> Alterations and/or recommendations------------ -•- --- -- - ----------------------- --------------------------------------•-------------------- -_---------- <br /> -----------------------------------------• -------- ------------------------------------------------------------------------- ----------------------------------•------------------•---••--------------- <br /> ------------------------------------- ---------------------------_=----------------------------- ------- •----- ----------------- -------- --------------------------------------- --------------------- • <br /> FfNAL INSPECTION BY: E Date_ --- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOOD 12.54 <br />