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APPLICATION FOR SANITATION PERMIT Permit No. ._� .f- _.____ <br /> w�/7 <br /> Y (Complete in Duplicate) <br /> Date Issued __?_L�_�s__J <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 /> �G W.2J � <br /> JOBADDRESS ANDG�L CIAT - ------------------- ------------- - ------------- --------------------------------- <br /> Owner s Name ! !. ------------------------- - Phone- 3 �� <br /> !- <br /> ----------- <br /> Address----------s. ��� o---------- � ----------------------------------------------------------------------------------------------•----•-------------- <br /> Contractor s Name y "�-' " -----•--------------------------------------------•--- Phone C�---�44_�_. <br /> Installation will serve: Residence Apartment House ❑h-•Commercial E] Trailer Court ❑ Motel,[] Other ❑ <br /> " //Q I i <br /> Number of living units. __-- Number of bedrooms _c 7 Number of baths _ ._ Lot size ._b-______ --- :.__-.Q---- --------------•- <br /> Water Supply: Public system Community system [I Private ❑ Depth to Water Table SM-_ ft. <br /> F <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adobe Hardpan E] <br /> Previous Application Made: Yes ❑ No/br New Construction: Yes E] $.NOXA <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ... <br /> (No septic tank or cesspool permitted if public sewer.is available within 200 feet.) <br /> Sep ' Tank:. Distance from nearest well--;--------------Distance from foundation--------------- Material------------.--------.------_-_--___.__..__---. <br /> No. of compartments--------------------------s Size--------------------------------Liquid depth--------------------------Caacit <br /> Dispos I Fi ! : Distance from nearest well-----------------Distance from foundation-------------------.Distance to nearest lot line----------------- <br /> Number of lines--------------------------------- -Length of each line-----------------------:-- --.Width of trench----------------------------------- <br /> Type of filter material-_-------_--- _ ._______Depth of filter material____.___-.__-.----`-.Total length______________________________/________---. <br /> Seepage P t: Distance to nearest well -t Distan r fo ndation_. -.___. �taance to nearest lot line_/.�___-_-. <br /> Number of pits----�-------------Lining materia_C�`-�---Size: Diameter.---------.........----Dep#n_._.. -------------_--- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material---_.-_-------..-.-.-__.______----_- <br /> ❑ Size: Diameter-- -----------------------------------Depth--------------------- -----------('"____ ..------Liquid Capacity.----------------- ---------gals. . <br /> ------------------------------------Distance from nearest building------------------- <br /> Privy: Distance from nearest well------------- <br /> . <br /> ❑ Distance to nearest lot line--------------------------------------------- ----------------------- =-------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):------------------ --------------------------------------------------------fi•---------------------------------------------------------------------- <br /> --------------- •----•-------------------------------•--- <br /> ------------•-•---------------•---•------ ------------------------------------------------------------------------------------------------ <br /> ------------------------------------ -•----------------••---------•-------------------------•-----------------------------•--------•----------- ----------•-------------------------------------------- <br /> I hereby ,Ay that I have prepared this application and that the work will be 6ne in accordance with San Joaquin County <br /> ordinances, �faf�elas, and rules `regulations of the San Joaquin Local Health District. <br /> (Signed) -------- ---y-- ---.--- - ---- caner and/or Contractor] <br /> ----- - ----------------------- 1_� -- 4�1 -.- `��" " {Title]--------- -------------------------------- --------- ------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildi gs, etc., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------------- <br /> - ----------------------------------------------t ---- DATE------.>----------- ------------------------------------- <br /> REVIEWEDBY----------------------------------------- ---=------------------------------------------------------- DATE---------� ------------ -------------•-------------- <br /> BUILDING PERMIT ISSUED--------------------------------- DATE....... <br /> -- -----__-_-- <br /> Alterations and/or recommendations:-------- ------------ ---=--- - -----------------------------------------------------------•------- - ---- `t—----------------­----------- <br /> ---i---•-- ----'- -- - -t`�---- - --- -- - - - _.---- . �.--- ------•--------- <br /> �-'S = <br /> -------------------- ------------------- ---------------------- ----------------------------------------------------- <br /> --- ----------------------- <br /> FINAL INSPECTION BY:..--- - "- ----------------•---------------- Date.--- !--T--�4_ E---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stock+on, California Lodi, California Manteca, California Tracy, California <br /> L•"_9 145446 ATWOOD <br />