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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> -7------------------ <br /> 0#1\A, pplica+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-------- ----- 4-e------ -------------------------------------------------------------------------------------- <br /> Owner's Name------. ----------------------------------------------- ---------------------------------------- Phone/VNP.. <br /> Address--------s,�_11 -7-1------------_-----_------_ - ------ -------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name----------- <br /> ------ ----------------------------------------------------------------------------------------------------------- Phone.........-------_------------.----- <br /> Installation <br /> hone...................................Installation will serve: Residence g?'*-A-partment House E] Commercial [] Trailer Court [] Motel [] Other F] <br /> Number of living units: ./.... Number of bedrooms 2—. . Number of baths _/.... Lot size ------------- <br /> Supply: Public system El Community system [] Private Ug-*'0e_pth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam E] Clay C] Adobe 8-FTa-rdpan F] <br /> Previous Application Made: Yes [-] No RrNew Construction: Yes T-'90 El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest welll .......Distance from founclation.10----------Material-_e.q-.-4 -I-- <br /> ------------ <br /> 1�9 No. of compartments---------4 L---------------Si,e_�XtXS--------Liquid depth___'e/__'774.._....._Capacity_. <br /> Disposal Field: Distance from nearest Distance from founclation../1--p........Distance to nearest lot line. . <br /> S. <br /> Number of lines--------------I--- Length of each line__-_ ........• Width of trench-----Z. ------------ <br /> Type of filter material-____ Depth of filter rnaterial_ _____________Total length------ ----------------------- <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation....................Distance to nearest lot line__._.....___..... <br /> 171 Number of pits______________________Lining material---------- ------------Size: Diameter____.......-._._-_.__-:Depth-----_---- --------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material._:.-.__-_.______.-_____-.-.-___-____. <br /> ❑ <br /> aterial------------------------------------- <br /> 0 Size: Diameter--------------------------------------Depth--------------------------------- -----------------.Liquid Capacity--•----•-------------------gals. <br /> gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line-.--------------------------------------------------------------------- ---------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):......................................................................................................................................................... <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <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, x State laws, and rules and reg I tion of the San Joaquin Local Health District. <br /> ,k�(Signed)------4,4V................. - -----_----- -- --------------e-------- -----------------------------------------------------------------(Owner and/or Contractor) <br /> By:-------------------------------------------------------------------------------------- ---------------------------------------------(Title)_ <br /> 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---------------_------------ ------ _W............................................ DATE--------7�_ �......... ........ <br /> ,,5 <br /> ----------------------- <br /> REVIEWED BY----------------------------------------_--------1&4-------------------------------------------------- DATE--- ....................................................... <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ ------------------------------------------------------ <br /> Alterationsand/or recommendations:--------------------- ......................................................................................................................................... <br /> ..............................................................---------------------------------------....................................................................................................................... <br /> ­-------------------------------------------------------------------------------­­----------------------------------------------------------------------------------------------........................................ <br /> -------------------­---------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------­-------------------------- ---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ,4-- zo - <br /> FINAL INSPECTION BY----- Date........ .............I------------------------------------------------------ <br /> - ------------------------------------------- ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E= 2M 145446 ATWOOD 12-54 <br />