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1 APPLICATION FOR SANITATION PERMIT Permit No. --.. a <br /> (Complete in Duplicate) 1Z�b -a- <br /> Date Issued --------------1f <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 Countyl0rdinance No. 549. <br /> Cf.s7� J f CO3—/70-27 <br /> JOB ADDRESS .ND CATION' . "Vj :r` ---- ------ ---------- <br /> Owner's Name.- .. f/" `� --------------•: ----- Phone <br /> Address _' - ----- ------- -..,.------- <br /> Contractor's Name------- ------------•---------- ----------•------- •-- ...--. Phone----------------------------------- <br /> Installation will serve: Residence] Apartment House ❑ Commercial ❑ Tra11ilsr ur..1t ❑ Motel ❑ Other ❑ <br /> Number of living units: _-I---- Number of bedrooms -- - Number o .-baths�T-� Lot size .- - ----------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Number <br /> to Water Table -- ---- ft. <br /> Character of soil to a depth of 3 feet: Sand'❑ Gravel ❑ Sandy Loam M Clay Loam Clay E3Adobe ❑ Hardpan ElPrevious Application Made: Yes E] No [*/ New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if epbl'c sewer is available within 200 feett) <br /> Septic Tank: Distance from nearest wel Dist fro fou ation_ L/------.-....Material____-___.______----k____._._i'�,;o <br /> [ No, of compartments--_-___--.J .--.-'.Siz -_- - - ___Liquid �epth_____ ____ ___________Capacity----- <br /> �,,� ��� r <br /> Dispos I•Field: Distance from nearest well��. :..Distance from foundation_ ___.- Distance to nearest lot line.# -_� <br /> [ Number of lines-------4161"�' <br /> __---- -Length of each line_- ----------- Width of trench____1��.. -- --_---_._-- <br /> t 1 <br /> Type of filter matersp g <br /> fDe th of filter material-------- -- -------Total len th---_-___-----� --------.......... 1 <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--_---------.---. <br /> ❑ Number of pits----------------------Lining material.......................Sizer.Diameter-----------------------Depth__----------------------------_-_ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation___-------------_ Lining material-_..--_.--.__---._._-----.-------- <br /> Size: Diameter--------------------------------------De th-------------------------- -x-------------------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):-------- --------------- -------- ---------------------------------------------------------------- -----------------------•-------------------•---- <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, ] rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---------- ------------------------- ----- ------- ----------------------------------------------------(Owner and/or Contractor) <br /> By:--- ------------------- -----�� — --------• �.---�---------------------------------------(Title)---------------------------•------------------------------------ <br /> (Plot plan, showing size of I. t, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> w <br /> FOR DEPARTMENT USE ONLY 1 <br /> APPLICATION ACCEPTED BY- - DATES. <br /> REVIEWED BY---------------------------- - ----------------- ------------------------- ------------------------------ DATE--- . - <br /> BUILDING PERMIT ISSUED-_-------5-,,)---------------------------------------------------------------------------------- DATE----- ts%l ---------------------------------------- <br /> Alterations and/or recommendations--- ----------- -- ------- - - - --- - ---- - -------•--•----•--- ------------ -------------------•----------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------•-------------------------------•-----------------------------.:.-----------------•------------------- <br /> ---------------------------- ---------------------------------------------------------------------------------------------------•--•------------- --•-----------------------•---•-----•-•----------------------------------- <br /> ------------ ------------------------------------------------- ------------.-------------------------------------------------------------------------------------------------- -------------------- -------------------- <br /> -1 y <br /> FINAL_ INSPECTION BY:.-- ' Date .La------------------------------------------------------------ <br /> SAN <br /> ---SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> Es-9-2M 145446 ATWOOD 12-54 <br />