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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) 7 — <br /> 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 described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> O cl y �fSv r Ljd f"/3 <:1 L r E'i? �C vwyv✓ LfJ Frsi O-ct Lc /m.f �_.t c� <br /> JOB ADDRESS AND LOCATION_-_� r, .....k?, _ _._-�� .:_-_- ` Y____T�sl��n•_ <br /> OwnersName--- 1 ------ ...................................................................................................�------------•------- ----;r------ --�---- ------��-'------------------------------- Phoria.----------- '-_- ��� <br /> Address .: - -�'Y===_� _� ------------------------------------------- <br /> ,- 1 r <br /> Contractor's Name------ �"V)iZ_ ='/�- ------ :... = cfi-- ...------ ------ Phone----------------------------------- <br /> Installation <br /> ------------------------- <br /> Installation will serve: Residence ©-- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/-_- Number of bedrooms -.._ Number of baths :'..__ Lot size ...... zi A c--- <br /> Water Supply: Public system ❑ Community system ❑ Private f;q Depth to Water Table __yP ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ <br /> Previous Application Made: Yes ❑ No El New Construction: Yes 0., No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_______________-Distance from foundation--------------------Material--------.--------..--__----..__-..-._----_----- <br /> r ' No-of compartments............... _--Size._..__---_.-__-----__---------_-Liquid de th.....__.____..__..._..----Capacity <br /> Disposal Field: Distance from nearest well---- _..Distance from foundation----PZ.4:�.......Distance to nearest lot line---- �42_ <br /> Number of lines------ ---- -Length of each line-- --� 6�- `` � <br /> 0 �-•-y---�T----•--, 9 � -� ----- Width of trent •_ .>:_....- <br /> Type of filter material-__��__.._.��Depth of filter material..__�_..`lz-_._.......Total length___. - _ ! It <br /> Seepage Pit: Distance to nearest well---L4_k..........Distance from foundation_-_.___1__.Distance to nearest Iot,Ji e_ _ <br /> ❑, Number of pits------/-------------Lining material---l-tt..c._/.Size: Diameter--..... _ Depth.._... __.-.__._-__ <br /> Cesspool: Distance from nearest well___--------------Distance from foundation------------.-------Lining material...-..,_----------------------------- <br /> . <br /> . <br /> ❑ Size: Diameter.---- --------------------------------Depth----------------------------- ----------•-----------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 /> 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 a. s, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) -,:I, <br /> ----- -- .... ". (Owner and/or Contractor) <br /> ---------(Title)--------- = °---------------------_----- <br /> (Plot 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 /> f�J <br /> APPLICATION ACCEPTED BY. ,------------------------------------------------------------------- DATE.. <br /> REVIEWEDBY------------------------------- ...------------------------------------------------------------------------------ DATE-------------------------------••------------------------ <br /> BUILDING PERMIT ISSUED------------ - -------------------------- ---------------------------------------------------- DATE-•--- <br /> 75 <br /> Alterations and/or recommendations----------- --- ------------------------- ----------•---•--------------•--------•----.•...---------•---.. <br /> ••------•-•-•-•--•------------------------------------------------------------------------------------- ...................................................•--••-•---••-----•--•----•-•-•.................................. <br /> -----•------------------------------------------------ ---------- ---•-------------------•••--•-----------••---••---•-•----•---•••------•---------••---------•---------••-•................................................. <br /> ••--•--•---••------•--••----•------•---•--------•••---------•--•-•---••-•-•------------•-•-•-•••------••----------------••-----••------------•-••------•-•-••-•-•-•-._...•-••------••---•---•-------•--•-------••-------•.--•- <br /> 17 atm _ <br /> FINAL INSPECTION BYAl <br /> '__` G. _�............... <br /> Date ' "} `3 -------------- <br /> i <br /> I=I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> r <br /> Stockton, California Lodi, California Manteca, California Tracy, California. <br /> ES-9-2M 145446 ATWOOD 12.54 <br />