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r <br /> APPI_ICATIO,N ..I`QR SANITATION PERMIT-�` erm�'it No. ---------- <br /> (Complete <br /> _____.(Complete in Duplicate) L �7 <br /> Date Issued __-.._�1-_. -�?__ <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 County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION___ 2 ",t"`r��-�­- c.--. ` r---`'=='•--� �.--rr-----`--'---------------------------------------- <br /> Owner's Name-------•-1 ' iIf-----= !J`- - Y! .F <br /> --------•---•---------e---- - -- -------------------------------- ----------- one.---------------------- ------•--- <br /> Address ------ - -------------- ----=-----------•-='-- -- ,'--- - -- ---- --------------------------------------------------------------------------------------------------- <br /> Contractor's <br /> ------------•--•-------------f------1---_.. <br /> Contractor's Name..............--------------------------------------- -=-- Phone_F_. <br /> -------------------- <br /> Installation ❑ ❑ ❑ _ ❑ , Other ❑ <br /> Installation will serve: Residence- Apartment House Commercial Trailer Court "Motel <br /> Number of living units: Number Number of bedrooms __I-_-. Number of baths __; Lot size ___.__- ._____",f______--_''-".---_---.--___ 1 <br /> F � <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 El'/Hardpan ❑" <br /> Previous Application Made: Yes ❑ N6\,d New Construction-. Yes es No I-],: <br /> TYPE OF "INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.V <br /> 'Septic ank: Distance from nearest well_ter +_..�__Distance from foundation X.......... aterial_-r--�3 _-- _ --- <br /> L1 No. of compartments-----------�`�.... ------Size----�x-- - ----------- Liquid `rJepth------t=1 <br /> Disposal�Fie'ld: Distance-from nearest well-----------------Distance from foundation-----'-'--- <br /> ­­Distance to nearest lot line----------------- I <br /> t/ ❑ Number of lines------------------- '-___Length of each-line--------------------------_-_.Wiclfh,of trench'__---------------.------------.--- <br /> ! Y� I rl. <br /> r t.'✓✓ Type or filter material------------------- Depth of filter material__________________ ___Total length_____:_:____:______-__..__._____.._._ <br /> _._ ) <br /> z-�°-' Distance to nearest of line!-r_= <br /> Seepage Pit: Distance to nearest well_.___._.________..____Distance from #oundation__.._ _...___-__ { <br /> . . <br /> ,i E Number of pits------ -----•---____-Lining ma"teiial_=_'-----------------Size: Diarmetr.------- --------- - - p� ✓ i <br /> 3 i ��—� �- ii r2 De.th <br /> Cesspool:I Distance from nearest weiL______________ _Distance from foundation.-.----.-.- __-__.Lining material '__ ...__-------------1_ <br /> ..__-__-.I._-__Liquid Ca acit i als. \ ' <br /> ❑ Size: Diameter. } Depth 9 p Y __g [�V <br /> 'Priv Distance from nearest well-------------------------------------------------Distance from nearest building <br /> ---------------------------------------- <br /> ❑ i Distance to nearest:lot line_______________ 4 �_ <br /> Remodeling and%'or re 'ng�[�#e cribe�:----- ;'-.-- --= �_ _:' _. _......� ! . ..s _-' `•-----_-• <br /> :. <br /> // - <br /> l.�..t' <br /> -------------- - ---- -J ---------- <br /> --------------- -------------------------------- <br /> - - - <br /> ,/I hereby certify that I have prepared this application and that4lhe 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 /> { <br /> (Signed)...I.-•:--'------}'`-.�_-'.__...-=---------- -----"- • - - --------- --- ----------------------------------------------------(Owner and/or Contractor) <br /> BY:----------- y" ------------------------------------------------------------------------------------------ Title------ ----------_A ------------- <br /> (Plot plan,showing size of lot,4ocation.�of system in relation to wells, buildings, etc., can be placed on revee!r side]. <br /> —FOR_DEPARTMENT.USE ONLY <br /> APPLICATION ACCEPTED BY DATE ------ ----------------- <br /> ---------------------------------- <br /> - I <br /> r <br /> REVIEWED BY----- �------- DAL"_-7- % ------------------------------- <br /> BUILDING PERMITJSSUED------------------- - ---- DATE--------------- _ <br /> Alterations and/or recommendations:-_ _. . ....M _.__. ''____ <br /> ------------ -��� c.Q !l� -rte tall c.�: ! gir +C / �'•------------ <br /> '"� � ' - -. --------------- <br /> -- ---- ------ ----------------- - ------------------ <br /> -------- <br /> ,:.. <br /> . _ <br /> FINAL INSPECTION BY: ---------------•- .. Date. - .`' ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh'`American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sheaf <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> r"-!3 < 745446 ATWOOD f � <br />