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APPLICATION FOR SANITATION PERMITe� 0 <br /> it No. ._ .°.�_.`f...:. <br /> U n +. <br /> (Complete in Duplicate) Issued _ 4 ._. _3_Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct annstall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 15, <br /> JOB ADDRESS AND LOCATION---- <br /> -------------ON__._ ��' ____ __�___7s�✓____.....l_ _'__. C . ?'......... <br /> ' <br /> G _ _�_.......... <br /> Owner's Name l � -! - Phone. <br /> Address... is Phone <br /> vwus/e <br /> ............... <br /> Contractor's Name Phone <•----(•J•----------------------- <br /> Installation will serve: Residence Q_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __{-_ Number of bedrooms __1____ Number of baths __{___ Lot size .....&fJ_....}t-__j'air_0........................ <br /> Water Supply: Public system ❑ Community system (I Private ❑ Depth to Water Table .46—ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobejg- Hardpan ❑ <br /> Previous Application Made: Yes ❑ No J' New Construction: Yes g No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r � <br /> Septic Tank: Distance from nearest well•_ ` ___Distance from foundation__��_..______.Material_�_ _ ./ �c.� '___.___._. <br /> No. of compartments_-___--_'.—_--__-___Size___, Le., .__Liquid depth____ ____ _______capacity.....A&W........ <br /> r <br /> Disposal Field: Distance from nearest well.- ._Distance from foundation..../(...........Distance to nearest lot <br /> [� Number of lines------------_/___-_ Length of each line... ......Width of trench._.��_'r._____.___.__. <br /> �r---- <br /> Type of filter material___ r� n _ __ <br /> ,__-_ iDepth of filter mateal_ _�__ _ ___.-Total length...... _______________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of pits----------------------Lining material----------------------- Diameter.......................Depth------- _--.•---------------- <br /> Cesspool• Distance from nearest weir-------------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 /> W <br /> Remodeling and/or repairing(describe) -•------•-•-------------•----•--------------•---••-•--------•------- ....................-------• `© <br /> ----------------------------------•-----------------------•---._.----•---•------------------•----•--------•---••----•-•--------•-••--•--•---•-------------•------...........-................................................ <br /> ---------------------------•••---------••- --•----------------•••--•---------•-----------------•------•---------------------•--••------------------------•-••---••-----•-__.._____..._...__._._...._---••---• .............. <br /> I hereby certif at I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Staf�� and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)______ __._ ,C...... . ...........Ij---_ IC-1 --'--------------------------------------------------------------(Owner and/or Contractor) <br /> "_(PlBy:- = (True) '�= ''T'---------------------------------------- <br /> (Plot <br /> ot plan, s owing 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- <br /> REVIEWED BY..............................--;4-t�--------------------- ---- --- ----__ DATE__..,-?. ------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------7--- ----------------­---------- DATE.- "........................... -----•---•--•- <br /> Alterations and/or recommendations:--------------_------------------------ .__.___ZS' <br /> ..-----•----•-------•.._...-•------•---------------••---•-•---•-•--•- -•---•-------------.._.._._...._....-•---••-•----••-----------•-•------•-•-•-----•••--..._..._.._.._...---.._..•----------_-._....-----------•---------- <br /> --.._..---•-•-•-------------------------•--•-••-•-•------•---••---••••------------------••---•----•-------•--•---•••-••----.-.._...-•------•--------••--.....•-----••-•-•---•-------•...._-._................................ <br /> FINAL INSPECTION BY:----------------------- <br /> - Date.................. ------•--•---- <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 />