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APPLICATION FOR SANITATION PERMIT Permit No- ----_ lJ-�x_.lJ <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 made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION _ `------- - -- .p. -r /�I� - <br /> - / % � ,�k . <br /> f` i' ------------------- f <br /> r� U <br /> Owner's Name, --- t I?hone-----------------------•------------ <br /> Address------ ... == 1r= <br /> ------------------------------•------•------------------------- <br /> Contractor's Name. '= ��-'fi�� Phone---------- ------------•----------- <br /> Installation will serve: Residence <br /> p Apartment House ❑ Commercial ❑ Trailer Court 9 Motel E] Other E],Number of living units: _--t--- Number of bedroomsNumber f�baths I-_ Lot size --�'�I t� - �--_-_-2*26 <br /> / - o <br /> Water Supply: Public system ❑ Community system ❑—Private• V "Depth 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 W New Construction: Yes - No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> .- I <br /> (No septic tank or cesspool permitted if Public sewer is available within 200 feet.), ` # , <br /> Septic�Tenk: Distance from nearest well__:_�DDista c frgo�rm foundation- _____ _� _-_-Material---___------------------------- -`:---__.---. <br /> MNo. of compartments-----___- r_r__.._'.--Si e -- _ - ---_--Liquid depth___- 147, Capacity---. __ _ <br /> Dispos ('Field: Distance from nearest wef stance from foundation--1-0_ rDistance to nearest lot line- <br /> Number of lines----- -Length of each line------------- / <br /> >-.�.-.Width of trench--- <br /> -----------Type oz filter materia-- . _l�` Depth of filter material---______ __C�----.-Tota€ length--- \ <br /> Seepage Pit: Distance to nearest well___-----------------Distance from foundation--------------------Distance to nearest lot line---___-__.----.- 5/) <br /> ❑ 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. _9 <br /> Privy: Distance from nearest well.---:-,`--------------------------------------------Distance from nearest building --------- <br /> ❑ Distance to nearest lot-line------------- ---V_ A,---—` <br /> a <br /> Remodelingand/or repairing (describe):-------------------------------------------------•------------------------••----------•--•-•----••-------------------------•--------------------------- <br /> --------------------------•_-.....-•---_.-_--._----•_---------.--__---.----___-----..-_._-.----------- -----_---------------__-_-_-_----_----------__•------_•-----------__--------------•-------------_-_-_---- <br /> ----------------------------------------------------•--------•_------------_---------------•--------- <br /> 3 F <br /> ----------------------------------------------------------------------------•-------_--_-----•-•-_------------•---_-_-- --------------------------------------._----------------------------••--- -------------------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> . P <br /> (Signed)_:- -- -- 1 <br /> -- ----------------------- = (Owner and/or Contractor) <br /> By:. ----------; ---------------------------------------------(Title)---------------------------------------------------------------- <br /> 1 <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed 'on reverse side). I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _-- _. _._ I i <br /> ------- •------------------------ DATEn�Z--------------------------------------------------- <br /> --- <br /> BY------------------------------- <br /> --------------------------------------------- - --------------------------------- DATE-- <br /> ' <br /> BUILDING PERMIT ISSUED ---------- ------------ DATE-------c. - <br /> ------------------------------------------------------------- -- --------------- <br /> Alterations and/or recommendations------------------- ----------------------1 -- - ---------k------------__- -------------------•-••---------••---•--------- I: <br /> J=` n..-....; 1' y--------- -----------0---- <br /> -_---0- _`--`------------------------------- --------- -------- <br /> --------------------- `---- o----.-- <br /> --- --•--• <br /> FINAL INSPECTION BY:----_-.._-.----. .- --------------- Date----------- � r`5 <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 /> ES­9-2M 145446 ATWOOD 12-54 <br />