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7 6` <br /> l APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) c� <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 /> JOB ADDRESS AND LOCATION------------ --Y- --` ------- -4 - <br /> ---------.-: <br /> --------------------------------------------------------------- <br /> Owner's Name. ✓` ` -----7.o---v---v--- �-- = --------------- Phone----- 1 --------- <br /> --------------------------- <br /> Address------------------------------------------------------------------`""..v__. --------------------------------------- <br /> Contrac+or's Name------------------------------------------------------- ------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence 2q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms --/-.:..Number of baths I--- Lot size --------- -�-��-U--------------------- <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 2� Hardpan ❑ <br /> Previous Application Made: Yes ❑ No �g_ 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 foundat.ion__.ld__.__--_.Material_---------------- ----------------------------- <br /> No. of compartments-_----�-------------Size----_--��_xr-- ------Liquid depth------ --6--........Capacity------------- <br /> posa -- <br /> Disl Field: Distance from nearest well_-__. `""Di'starice from founti <br /> daon---.-`U--.-.-.Distance to nearest lot line----2__1... <br /> Number of lines----------�2---------------------Length of each line-------------�- ----Width of trench---- a-`�f---------------- <br /> Type of filter material- . ----- Depth of filter material---..---f�___-_.Total length----------------1169Q--------------- <br /> Seepage <br /> -------------- <br /> Seep ge Pit: Distance to nearest well---------------------Distance from foundation-------------------.Distance to nearest <br /> lot line----------_---.-_--. <br /> ❑ Number of pits- -------Lining material- Size: Diameter-----------------------.Depth--•--------------------------- <br /> Cesspool: - <br /> Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------.------------------ W <br /> Size: Diameter----------- ------------- `De th------- -=-- --------Liquid Capacity gals. <br /> Privy: Distance from nearest well------------------------------------------Y:-.--Distance from nearest building <br /> ❑ Distance to nearest lot line---------------- <br />, Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------- ------------- <br /> ---••-----•------------------•-•--- ------------------------------------------------------'-------------------•........------------------------- ------ ------•---------•--•---------------------------------------------- <br /> ---------------••-•------------- -------------- ------------------------------------ ---;----------------------------------------------------------------------------------------------------------------------------------- <br /> 1 hereby certify that I have prepared this application and tha+ the work will be done'in accordance with San Joaquin County <br /> ordinances, State laws, and u s and re• ulations of the`San Joaquin-Local Health'Distr'ict. <br /> (Signed) -- ------- <br /> •- -- ----- ��e--- -- 1-.--(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 /> APPLICATION ACCEPTED BY---- --------------------------- -------- ------ ----------------------------------1--- IRATE----------- <br /> - - --- <br /> REVIEWEDBY------------------- ------ ----------- --------------------- ---------C------- ----------------------- ` =-----'(1----- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED ------1--------- <br /> ----------------- - DATE ------------------------------------------------ <br /> Alterations and/or recommendations: t -��------------ - -- --------------•---------•------------..----------------------.-....._._.- <br /> -------------=- -- -- : -•-------A� A------------------------------------•-•------------------------------•---------- <br /> -----•--------------------------------- -- ------------------------------------------------/� - ---------x- - --------------------------- ' ----------------- -------- ------------------- <br /> FINAL INSPECT.ION .BY:-:...- -------.-_..-_._ - = -° '� �-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 /> E5-$-2M 145446 ATWOOD 12.54 <br />