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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate), Date Issued <br /> TZ4 ej '_ -1 <br /> Applical-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 L0�CA&Tl1l00..N';14__ <br /> Owner's Name---- <br /> ------------------- ------------------ Phone.------ <br /> Address--------• <br /> hone-------- <br /> Address------------- Ke�40--------------------------------------------------- <br /> ------------------------------------------------------------------------------------------- --------_------- <br /> Contractor's Name_ ------�*_ <br /> ----------- --------------------------------------------------------- -------------------------- ------------ <br /> Installation will serve: Residence EE( Phone <br /> Apartment House C] Commercial El Trailer Court [] Motel [] Other C] <br /> Number of living units: I---- Number of bedrooms -_1_"-- <br /> ­ Number aths ---/--- Lot size 7A,- -A-0 .00 <br /> Water Supply: Public" sysfe(n Ej Community sysfem E] Private _f--------------------------------------------- <br /> I ; .. �Dpfh'fo Wafer Table-.7�-------ft. - <br /> Character of soil to a"de fh'of 3 feet: Sand Gravel-E] Sandy Sandy Lo;m;4eE;K Clay Loam 0 ClaM/ <br /> Previous Application Made: Yes 0 No <br /> 7 <br /> N <br /> N ew Construction: Yes No E] <br /> y El Adobe Hardpan E] <br /> 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted liblic sewer i's available within 200 feet) <br /> ank: # <br /> Septic Distance from nearest wel4?)4Vb*11`T_aj1 f f o o n a f real-_ <br /> ---- --- - - -- <br /> r 00._ <br /> p__ <br /> No. of compartments---- ------ Liquid dppfh C&pacify. <br /> D;s VT ------------------- - ... <br /> Field: Distance from nearesf we I <br /> ct�e Md�' foundation kistance to nearest 11,6 -- ----------- <br /> 0 1 -------- <br /> Number of lines - !Length of each line----- ?5�0- Width of trench---- fV <br /> P/ -------- ------ - 7 <br /> Type of filter ma_;er_i 1h of filter material-7 <br /> A,d, A— ____f3,_.__,Tofal lengfh-I---- ......(20 <br /> Seepage Pit: Distance to nearest well-------------"--------Distance from foundation"-""__-."" n nearest lot line-- <br /> El Number of pits. !-- n -------------------Disfa%ceto ' --------------- <br /> I-----------------Lining material-------------- ----- -.Size: Diameter-------------1-- -----Depth---------- <br /> - <br /> Cesspool- 7- ----------------- <br /> Distance from nearest well-----------------Distance from foundation -,-----------------Lining.material------------ <br /> - <br /> Size: Diameter.- .-t------------I-------- . ........Depth------ ------------------------- <br /> ------------------------ ---------------------Liquid Capacit <br /> Iy----------------------------gals. <br /> I <br /> Privy: Distance from nearest well------------------ ------------------------------Distance from nearesfbuilding---------- <br /> es <br /> T ------------------------- --------------------------------------- ---------------------------------------------I <br /> 171 Distance to nearest lot line -------------------------------- <br /> Remodeling and/or repairing (descrL]:------- <br /> --------------------------------------------------------------- --------------------------------------------------------------------------------------- ------------------­---------------------------------- <br /> I -I----------------------------------------------------- ----------------- -------------------------------------------------------------I----------------------- <br /> -------------- ----------------------- ----------------I----------­---------------------------------------------------------- i <br /> I -----------••-------"•---•-----•--•-------------•----""---------- ---------------------------- <br /> ---------------------------I----------------------------- ---------------------------- <br /> --------------------------------- ------------------------------------------------------------------ ------------------------I-----------------------------------------11-------------------------------------- <br /> I hereby ce ififha+ I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Star, laws�and-Qes ana'regiulafions of the San Joa uin Local Health District.ul friv Jan <br /> {Signed)-- ------------------------ <br /> By:------------_------------------- -------------------- ----------------------------------------------------------I (Owner and/or Contractor) <br /> (Plot plan. showing size of lo_ cation of sys- ----------------------- ----------------------------------------(Title)--------_1 <br /> ---- ---- - ---- -------- <br /> �Vlm in I relation to W611s, buildings, etc., can be placed 4'on--reve-rse--side). <br /> FOR <br /> ide)-FOR DEPARTMENT USE ONLY <br /> ---------- <br /> APPLICATION ACCEPTED W R— <br /> REVIEWED BY ------- -------------- - ------------------------ DAT ---------------------------------------- <br /> ------- DATE--- <br /> BUILDING PERMIT ISSUED----------- -------------------------------------------------------------------------------- ---- --- ------------------------------------------ <br /> -- - ---- ---- <br /> Alterations and/or recommendations:.-____".---."".--_' --- - -----------*- <br /> ------------------------------------------------------------- DATE.---------- --------------------------------------------- <br /> --- --------------- ........................ V\ <br /> -------------------------------------------------------------------------- ------------------------- ----------- ------------------------------------ -------------- 7-----------------*-------------- <br /> ----------------------------------------------- -------------------------------------------------------- <br /> :----------------------------------------I-------- <br /> ­­--- ---------------------------------------------- -------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------ -------------------------------------------------------- -------------- ---- ---------------------------------------------------------------- ------ --------------------------------- <br /> ---------------------------------------------------- ----------- -------------------------------------------------.......... ------------------------------------- -------------------- --------- -----------------_-- <br /> F[NAL INSPECTION BY-------------- ----- - <br /> --------------------------------------- <br /> Y:---- <br /> --------------------------------------- Date -7 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfrest 1300 West Oak Street 132 Sycamore Street <br /> 814 North "C" Sheet <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> F5___9_2M 145446 ATWOUD 12-54 <br />