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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) d <br /> Date Issued <br /> Applica{ion is hereby made to the San Joaquin Local Health D--rstr-sct for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS A LOCATION----------.Jr -�_- IV.4 -S / 5-- 11�-------- --------------------------------- <br /> - ,,` <br /> Owner's Name----- --•----- `',� �� �1[ e ------------------------------------------- Phone------------------------------------ <br /> Address-_,_- <br /> ---•------•------------ - <br /> Address--- - . ...... _ ___/P <br /> _ <br /> Contractor's Name------- ------.---- ---k- ----�----- ------ ------------------------------------------------- Phone--- r�p sly-7 <br /> Installation will serve: Residence [;§ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 1_____ Number of bedrooms.___ Number of baths __f--- Lot size _____/ __1 --_ --------------------- <br /> Water <br /> ----------------- --Water Supply: Public system [L 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 ❑ Adcbe j& Hardpan ❑ <br /> Previous Application Made: Yes ❑ No J�4_ 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 T k ante from nearest well------ ---------Distance from foundation--------------------Material____.--___-.------_____.__________.._.____ <br /> ❑ of compartments----- -------------- -----Size------•-------------------------Liquid depth----------- ------ Capacity y----------------------- <br /> - a acit <br /> Disposal Field: ' tante from nearest we€I------__........Distance from foundation--------------------Distance to nearest lot line-_..-_-_-__-____- <br /> ❑ er of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> ype of filter material_--_____---------------Depth of filter material-----------------------Total length____________-_-______ <br /> Seepage Pit: Distance to nearest well__/ ___Distance from foundation----lQ__ ......Distancp to nearest lot line--- <br /> '�, {dumber of pits-----/---------------Lining Diamete r___�S---------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 /> ------------------- <br /> Remodeling and/or repairing (describe):-- ----------------------------------- --------------__-----------------_-----• ••--------•------•-------------------------•-----------•------------- <br /> -------------------------------------------------------•---------------------------------------------------------------•------•----------------------------------------------------------------------------------------------- <br /> -------------------------------- ------------------------------------------•------------------------------------------------------------------•------- -- ------------ ----------•------------------------------------ <br /> I herebrel <br /> that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, s, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) --------�� '�----- --------------------------------------------------- -------( ner 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----- ------- '`--�=-v---------------- ---------------------------------------- DATE------ <br /> REVIEWED BY----------------------------------------------- DATE---------------_ -----------••------....._--------- <br /> -------- ---- ---------------------------------------- <br /> BUILDINGPERMIT ISSUED-----•---•--------- ------------------------------------------------------- ------------ DATE------------ ------------------------ <br /> Alterations and/or recommendations: ---�------------------------------------------------------------•-•-----•-------- --- � <br /> f� <br /> o ma- <br /> --------- ._ <br /> -----------------------�y-------­­­--------------- ---------- --------- ------ ------ ----------------------------------------------------------- ----------------------- ----------- --------- ....... <br /> --------------------------------------------------I-------------------------------- ----------- ------------------------------ --------------- ---------•------------- ----------- ---------------------------------- <br /> FINAL INSPECTION BY:...... ----------- Dafe. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOOD 12'-Sa <br />