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-------------------- <br /> APPLICATION FOR SANITATION PERMIT Perr7rui ---- <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....-- ---- --------------q-'2c'r�-`--'------------- -----•-------•------- -_ -----------I----------------------------------------------- <br /> Owner's <br /> _- <br /> Owner's Name-_ - •----• , �----------•-------------------- -- ----- ----------- -------- Phone--------------------------------- <br /> Address-------Z9/_d.,:.2............... .... - t.� <br /> -------------------------------------------------------------------------------- -------•-•--------------- -------- <br /> Contractor's Name_._... .......� — -----`4-----' - - --------•-•---------------- - ------ Phone._W_9r_-4_-_f_4G47- <br /> Installation will serve: Residence E� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---f__ Number of bedrooms __ Number of baths ---/.. Lot size __.J�_ __X_.--7 _ ________________________ <br /> Water Supply: Public system rV1 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 R] Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [N] Construction: Yes ❑ No Q <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septics Tank: � Distance from nearest well------------------Distance from foundation__._-____________--Material--------------------------------..._.------------ <br /> /A' JNo. of com artments---------- - - -----------Size------•-------------------------Liquid depth------------------------Capacity ---------- <br /> Disposal Fielo- 'Distance from nearest well-- -.-...........Distance from foundation--------------------Distance to nearest lot line--------._______- <br /> mber of lines-----------------------------------Length of each line----------.--------------------Width of french-------------------------------- <br /> ype of filter material-------------------------Depth of filter material_._.-____..._____...__.Total length_-___.--__-_____._-_._-_______________-__ <br /> Seepage Pit: Distance to nearest well..._________----------Distance from foundation-----/0_..........Distance to nearest lot line_._--1�---_----- <br /> Number of pits.__-_.!-_-____- --Lining material__�r.Ln.__ 1!ce: Diameter. ................Depth__._ ------------------- <br /> Cesspool: <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 /> F1 <br /> ------------ = <br /> ❑ Distance to nearest lot line---------------- ------- --------------------------------•-••------------------------------------- <br /> Remodeling and/or repairing (describe):------- ---------- ------- ----------- -----------•--------------------------------------•------•---- <br /> ------------- -------------------------------•--------a------•-----------••---------------------------------------------------------------•----------------------.---- <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. 1 <br /> (Signed)---•---•-- _ ''�- -----------__„lam- ,-- -----------------------•r--- --------------------------------- --------(Owner and/or Contractor) \; <br /> SY:---. v•-�--•-•w-�-�-^---- -- - - - -- -'�---------•------------------- •-(Title)-----------`�._=—'"'-'-=----.- -=---------------------------- <br /> (Plot 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 /> REVIEWEDBY----------------------------------------------- ------------------ --------------- -------------------------- DAT -- ------- ----5C•-----------••--------------------------- <br /> BUILDING PERMIT ISSUED._---------- -=------ ------------ --------------- ---•------------------------ DATE------ -- ---- ------ <br /> Alterations and/or recommendations- -------- -- - ------ ­-- - ---------------•-•---••----------------------------------------•---------•---- --------- t <br /> ----- <br /> FINAL INSPECTION BY:-----��04-5------------ ----•-- ----- Date ---------�- -- -------� .. g <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES--- 145446 ATWOOD 12.54 <br />