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APPLICATION FOR SANITATION PERMIT ► Zate <br /> mit No. ....$... ........... <br /> (Complete in Duplicate) Issued ------ ----------�-� <br /> � <br /> i <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and"i s all the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS A LOCATION_ /4V--- ....... <br /> Owner's Name -} _ hone <br /> . . --•--. --- i <br /> Address.......... ...... . -- --------1 77 _ <br /> Contractor's Name_ = ------------------------------------------------- Phone................................... <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motels❑ Other ❑ <br /> r <br /> Number of living units: /..__ Number of bedrooms ./... Number of baths .___.l. Lot size ..... 'Q......................... <br /> Water Supply: Public system ❑ Community system fg--Private ❑ Depth to Water Table _��[_. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe J& Hardpan ❑ <br /> Previous Application Made: Yes ❑ No W_ New Construction: Yes & No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet) A <br /> Septic Tank: Distance from nearest well. • ----•Distance from foundation__..16... �.<-----..........'x`-................ <br /> No. of compartments_---;--________-.Size-_S-7t...$_•�_G.___Liquid depth__.4.C7- _- Capacity.....��, - <br /> Disposal Field: Distance from nearest well_.------_Distance from foundation-__ _ Distance to nearest lot line,,,............. <br /> __-_Length of each line___/ <br /> Number of lines________________f'_�_______- g CPQ._____.___- Width of trench.__.,,_ <br /> r� <br /> Type or filter material._ y-___ ._Depth of filter material.-_. --________Total length__......._�/i_Q....................... <br /> Seepage Pit: Distance to nearest well---------------------- from foundation....................Distance to nearest lot line----------------- <br /> IN ❑ Number of pits----------------------Lining material--------------.--------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 /> 4 <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 �d <br /> ordinances, State laws, and rul and regulations of the San <br /> �Joaquin Local Health District. <br /> (Signed) ` = ' '""---------- -----------------'`-- - ----- •- -------- -- -----f� wne�ang or Contra #or) <br /> l .. ------------------------------------------ <br /> By:.- <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 /> APPLICATION ACCEPTED BY. --------------------------------------------------------------------------------- DATE-p,-�----------•------------------------------------------- <br /> REVIEWED BY-------------------------------- --•---------..-._--- ------ DATE--- <br /> ------------------------------.- <br /> BUILDING PERMIT ISSUED.------ . .------ -•---- DATE...... <br /> �5 --------------------------------------------- <br /> Alterations and/or recommendations------- -------------- ------------•--•--------------•-•-----••-•-------•••••-•--•--•------•--------••-- -•----------..------.------••-•--•------••-•---•- <br /> -------•------------------------------------------------------------------------------------------------- -•----------------------------------------•-----....-------------••--------•--------------------------•----•.---•- <br /> -----•----•--••----------•-----•-- --------- --------.......................................................................................................................................... ---------------- <br /> ---------- - <br /> i''�/ '' <br /> FINAL INSPECTION BY:............. ---..... 14, Date-_------------------- .-------•----•--•-•-•--•• <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet <br /> Stockton, California Lodi, California Manfeca, California Tracy, California <br /> ES-3 145446 ATWOOD <br />