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APPLICATION FOR SANITATION PERMIT Permit No. ..-, .. _5...... <br /> (Complete in Duplicate) <br /> Date Issued ._....-_T!.�.�... <br /> Applica4-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. 549.4f 2 OOS—loo_�U <br /> JOB ADDRESS AND LOCATION._.._ <br /> l-,I _� _______ _G! •ert-�. <br /> 77 <br /> Owner's Name f 'r Z4 {:^ -G Phone --! <br /> ------ . <br /> Address---------------- ---- '" ''�"e�_2----------------- - <br /> Contractor's Name-------------------------------------------------•------•------------------------•-----------•- ------------------- ------ Phone <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 .......................... <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 ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ 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-----------------Distance from foundation--------------------Material <br /> _.._._........___--....._.......--.....__...... <br /> ❑ . No. of compartments-------------------- ----Size---------------•----------------Liquid depth--------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well----7-5 . ...Distance from foundation.....---------.Distance to nearest lot line.-Z <br /> Number of lines------- ........,.. � ----Length of each line------7,�.-----------.-.Width of trench.-----x ................. .. <br /> Type of filter material... � f Depth of filter material------/,'!- `--------Total length___..7,.+f..'~........................ <br /> Seepage Pit: Distance to nearest well,---------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ {Number of pits----------------------Lining materia;-----------------------Size: Diameter---------------........Depth----------------------------------.� <br /> Cesspool: Distance from nearest well------------- --_Distance from foundation....................Lining material---------------------------------- <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 <br /> ---------------Remodeling and/or repairing (describe):....Ar- ' '"'t�----- � <br /> -,- <br /> --------------- <br /> _ <br /> -------------- e----------------------------- <br /> ---------------------- <br /> --•---••-----------------•- <br /> -- <br /> -:^u-•----------. .a�.-- ------ ---r osy---- --• ---� !` �'_ _ v--- ri-m ""-------------------------------------------------------------------------------------------- <br /> ------------•--•--•---------------•-----•-------------------------••---•----------- ----------------------- <br /> I hereby certify that I have preparecllthis application and that the 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 /> (Signed)---- d -- ---------------------------------------------- ------------------------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------------------ -----------------------------------------(Title)----------------------------------------------- ---------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 2 _* FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY �.. . .:. ----- - -------------------- ------------- ------------ DATE..r"-Vie";-�r�------ --------------- • --- <br /> REVIEWED BY ------- --------•--- DATE <br /> BUILDING PERMIT ISSUED------------------------------------------ --------------------------------...----------------------- DATE.. <br /> Alterations and/or recommendations----------- ------------------- ---- •- --------------------------------------- <br /> ...­-•-----------------------------•--------------•1--•------------------------------- --------------------------------------------------- -----------------•------------•-------•-••-------•--•------------------- <br /> ------------------------------------••-------------- _--------•--------•-•------------------- <br /> ----------------- ------------------------------------------------- ----------------- ----------------------------------- ------•-----•-------------•------------•-------- <br /> ----------- --------------- <br /> ------------- <br /> FINAL INSPECTION BY:. -- ----- -- -- -- ----------I-- --------------------------- Date---- <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 /> ES-9 145446 ATWOOD <br />