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(`; PPr 1N% <br /> LICATION FOR SANITATION PERMIT Permit No. ____1__.1------------- <br /> / {Complete in Duplicate) 1 <br /> d i! Date Issued _____�4(t__.__ <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to Sn5ruct and i sthe worlyherein described. <br /> Thisapplication is made in compliance with County Ordinance No. 549. �.r w , f <br /> d ------- -------- --9V ----------------- <br /> JOB ADDRESS AND LOCATION._.._________._._ �' �-- � � � -------------- <br /> 77 j ` ---- Phone----------------------------------- <br /> Owner's Name----• --���'-%y----•------G (J �_�C�..--•-------�•`�•-��-�--� <br /> /-_C ' <br /> Address.-------- -.��---�_.l_���{!_-��------------ ----��..�-�-----............•-------------------------------------....------------------------------------•-•----------------------------- <br /> Contractor's Name � .!_ ----------------- Phone---------------------------------- <br /> Installation will serve: Residence ®-- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1_--- Number of bedrooms ----- Number of baths 4_�E__ Lot size .--_- ------- _�______________________ <br /> Water Supply: Public system ❑ Community system ®.- Private ❑ Depth to Water Table A/__;� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe©, Hardpan ❑ <br /> Previous Application Made: Yes ®_ No ❑ New Construction: Yes Pa_ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> P - <br /> Septic Tank: Distance from nearest well- �a_:__Distance from foundation__./G'___...____.Material___C;---___�: ��---------- <br /> © No. of compartments-- - - --�----------Size_____h.4---lL_ - -----Liquid depth----Z�:o._`_`..._.__.Capacity.-j4�ZG'­4_ <br /> Disposal Field: Distance from nearest well...-:F0:0__._Disfance from foundation___. .6'--.--..Distance to nearest lot line__ _________ �p <br /> Number of lines----------- of each line______14 -----..}___.._.Width of trench._____f _ _��._-_-___ <br /> Type of filter material---- -y------5. .c-Depth of filter material---/__ ............Total length--------le_4______________________- <br /> Seepage Pit: Distance to nearest Distance from foundation__- Distance to nearest lot line----/Q-_r___ <br /> � .» _ , <br /> � Number of pits_._._---------_---.Lining material__e_�_._��'�ze: Diameter_____:��_rr_._.___Deptn_-__-_-�-_5—------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-------------------------------------- <br /> 171 Size: Diameter------ ---- -------------------------Depth------------------------------------ - -------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well---------------------------------___-------------Distance from nearest building----------------------------------------- <br /> ElDistance to nearest lot line--------- -------------------•----------------- ---------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):------------------------------------- -----------------------------------------------------------------------------------------------------•----------- <br /> -------------------------•--------------------•--------------------------------------------------------•---------------•----------------------------------------------------------------------•------•-- ------. <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;`pnd rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ffr (_ i/ :.Z '��fi`-- =_5 ' ------------- (Owner and/or Contractor) !� <br /> $y:. _- c.--r - d L ----------------(Title)---- `� --------•----- ------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> �t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- -------------- -- ---------------- DATE-------- -•-- -------------------------- <br /> - - <br /> REVIEWEDBY------- ------------------------ - ------------------ ------ ---- ---------- ----------------------------------------- DATE---------------�-- <br /> BUILDING PERMIT ISSUED. ------- - --------------------------------------------- DATE <br /> Alterations and/or recommendations---------- ----- - ---- ------ -----•--•-------------------------------- --- ••--------------------- ' ---•------------- <br /> ------ - <br /> ------------------ <br /> --------- <br /> -=--------- <br /> L------------------- ----------- <br /> - ._____ _-____- _ -- ------____________ _________ _ _______________._____ --_ _ ----------------------------------- <br /> -______.__ ________________._-___.__._ -___-_-- .________________.__. <br /> -------------_-------______ ____ __________________ -- __...__..--_- -----__..._.___-__.-_--____.-.-___---__.___._______----------__ _------_--____._._-______._______._.____.___--_. -. -.------ <br /> FINIAL INSPECTION BY:_.__"_�- - ------------------- ------------ Date--------�---- ---- ------ ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 N*rth "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES---9-2M 145446 ATWOOD 12-54 <br />