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V � <br /> APPU CATION FOR SANITATION PERMIT Permit No. L_---- <br /> (Complete in Duplicate) <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 trade in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--__?fT r,? <br /> x�----4_8--x �. <br /> Owner's Name__._._-_'_4-------------<—,<—,­!C_-;-./�--row-------------------------------------- - ----- ---- --------------------- - ------ Phone._. ---------- ------ <br /> -••------------------------------------------------------------•----------•--------------------------------- --------------------------------­-- <br /> Contractor's Name---- __- I[rR-i'_S'_ _-. _.Z-:,"esr_ �_r <br /> ------------------------------------- --- -- -•-------------------._ Phone.------•--`-------- •------------•- <br /> Installation will serve: Residence 9---Apartment House ❑ Commercial ❑ Trailer Court ❑ �Myotel ❑ Other ❑ <br /> / <br /> Number of living units: ____- _ Number of bedrooms - Number of baths ___/__ Lot size ------I-T:_C- <br /> ------- <br /> Water Supply: Public system ❑ Community system ❑ Private [depth to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe ID -Harcip <br /> Previous Application Made: Yes ❑ No Q/—New Construction: Yes E5--No ❑ <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 well--- -d-__"Distance fromJ'r foundation__-J-d-- --_,Material_ .�_----/p,��¢/ <br /> No. of compartments---- _- ------Size__.�C__-_d_�--_•---Liquid depth------ ------------Capacity---- + <br /> -d <br /> DisposalField: Distance from nearest well_---�CP--.-Distance from foundation-----2. -______.Distance to nearest lot line__- -d-�-- <br /> Q-� Number of lines------------- rr 7 ` t <br /> ------ ---------- -Length of each line-------•J----�- --.------.Width of trench-------�-y--��------------- <br /> Type of filter material.---1_&_�R----Depth of filter material___-_/jR-----Total length______--4-C1-0, <br /> r ------------- <br /> Seepage Pit: Distance to nearest well_/�-Q--_____--Distance from foundation-____7_Q-----.Distance to nearest lot line___ Ab- --17-- <br /> W-e Number of pits--------l-----------Lining material____'.- Size: Diameter____- ----Depth— <br /> Depth-_-- <br /> Cesspool: Distance from nearest well________________ Distance from foundation-------------------- material_-___-__.____-__-__________- -_ <br /> ----- <br /> Privy: Distance from nearest well---❑ Size: Diameter--------- ------------ ----------- Depth- ------------------•------ ---- ----- ---------Liquid Capacity----------------------------gals. <br /> -__-____-------------------------------------Distance from nearest building <br /> Distance to nearest lot line----______ --------------------------------------------- <br /> Remodeling and/or repairing (describe):____. <br /> ----------------•-----------------`------------------------ <br /> -------------------•--------------------------------------- I <br /> -----------`--------------------------------------------------------------------------------------------•-•-------------•--------------------------••-----------------------------------•----------------------------------- 1 <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, Sta­ , 'te -L-ws, and rules and regulations of the San Joaquin Local Health District. <br /> JeR1- Y - , <br /> (Signed)- ---•--- � s (Own and/or Contractor) <br /> ti ---------------------------------------------------------- <br /> BY: <br /> --------- •------------------- <br /> r SY: Z <br /> ------ -.�--••- `� <br /> (Title]----_--- <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> ------------------------------- <br /> FOR DEPARTMENT USE O L <br /> APPLICATION ACCEPTED BY----- -- ---_-- DATE-------_ <br /> D BY <br /> =- ---------- DATE----� <br /> BUILDING PERMIT ISSUED----- `: , ,� -----------•------ <br /> - = --- -- ------ DATE-------- <br /> --------- - <br /> Alterations and/or recommendations:_.-._ - .� --------`------------ <br /> `` r/4 <br /> ---------------------------- - _ <br /> ------------------------------------- - - --- <br /> FINAL INSPECTION BY:--- ------------_- y <br /> - ------ Date--------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street <br /> y 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California <br /> Traey, California <br /> 145446 ATWOOD ,Z-54 <br />