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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) 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 de cribed. <br /> K n <br /> This application is made in compliance with County Ordinance No. 549, <br /> . ............. ...... .... . .. ... ......... <br /> JOB ADDRESS AND LOCATION--OAJ— .� . . < <br /> 1-1 -1 -- - - `- -- - --- ------ -- ---- ------------ --------------- <br /> ................. <br /> Owner's Name_(11_12_61_$Lkx------------- ----- --------- ------------------_-__---------------- ----------- -------------------------------- Phone----------- <br /> Address-------- ------ —------------------------------------------------------------------------------------------------- <br /> Contractor's Name-------Q-,/1i --------------------------------------------------------------------------------------------------------- Phone--- --------------------------------- <br /> Installation will serve: Residence ,Apartment House El Commercial 0 Trailer Court El Motel D Other 0 <br /> Number of living units: J---- Number of bedrooms __j----- Number of baths j---- Lot size -__________________________ <br /> Water Supply: Public system El Community ;ystern E] Private�Depth to Water Table.___-___ ft. f 43+-I <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel [] Sandy Loam 0 Clay Loam 0 Clay E] Adobe ,Hardpan E], <br /> Previous Application Made: Yes E] No�t New Construction: YesA No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: -4 <br /> (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--5-6--1---Distance from founclafion-1-0 <br /> Q_________-.Material__!- ------- -I ----------- <br /> No. of compartments_._-. —--------------Size_�;)... ------Liquid depth-------4—__--- --- Cap, <br /> Disposal Field: Distance from nearest well-___--_------Distance from foundation------0-----------Distance to nearest lot line___ _____.... <br /> of lines_____________I--- ength of each line_____L.0...............Width of french.,- I----- _.______-____ <br /> Type of filter materiaI4%q.�-------------kb0KGf filter material---- --'-------Total length------ ---0---- --------------------- <br /> Seepage Pit: Distance to nearest weff- --------------------Distance from foundation__________________ Distance to nearest lot line_-_______ ------ <br /> El Number of pits.---- ------------ --Lining material-----------------------Size: Diameter----------------------Depth----- ----------------•------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-- _-____________.____-__-__.______.❑ I <br /> Size: Diameter--------------------------------------Depth---------------------------------- -----------------Liquid Capacity-.-------- -•---------------gals. <br /> -4 <br /> Privy: Distance from nearest well____-_--_-__-_-_-_ -- ---_Distance from nearest buildin❑ g--------------------------------------- <br /> Distanceto nearest lot line.,..................:------ ------------------------------------------------------------------------------- ------------------------ <br /> Remodeling and/or repairing ------------------­------------------------------------- <br /> ----------------------------- <br /> -----------­-------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- -------------------------- <br /> ------------------------------------------------------------------------------------------------------- ------------------- ---------I---------------------------------------------------------------------------- --- <br /> .14 <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 /> (Signed v&_ V_�_- ---- - ----------------------------------- ------------------------------------- -------------- ------------- --.----(Owner and/or Contractor). <br /> By:---------------------------------___-------------------------------------------------------------------------------------------(Title)------------------------ `---------------- -------I-------- <br /> (Plot plan. showing size of lot, location of system in relafio-n to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------- 1 ------------- DATE.----- <br /> ------------------------------ <br /> ------- --------------------------- <br /> REVIEWED BY----- ----------------------------- -------- -------------------- ---------------- -------- DATE--- ------- <br /> ATE--------------- ---" <br /> BUILDING PERMIT ISSUED---------------------------- ------------------------------------------------ DATE- ------ --------------------- <br /> Alterations and/or recommendations-------------------- ----------------------------------------------------------------------- ---------------------- <br /> ---------------------- -------------------- -----------------------­­------------------------------------------------------------------------------------------------:------------X4�_---------------------­----...... <br /> --------------------------------------------------------­­----------- ----- ------------- -------------------------------------------------------- ......-----------­­---------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- --------------------- <br /> ----------------------- -------------------- ------- ---------------V­i­_._�- ------- ----------------------------------------------- --------------- <br /> -------------------------------- <br /> --- --------- Date............... -------------------------------- <br /> FINAL INSPECTION BY-------- ------------------ ---------- ---- --- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy.'California <br /> ��g T45446 ATWOOD <br />