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V <br /> APPLICATION FOR SANITATION PERMIT Permit No. ------ <br /> (Complete in Duplicate) <br /> Date Issued -5�A _S <br /> d�►P�}�0.4 �.nl <br /> pplical-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. ff <br /> JOBADDRESS A L CAT N---- - --1-- ----�--'-��`----- ----`r--------•---�--------------- - ---- -----------------•--------- ----- --------- <br /> Owner's Name... ----------- <br /> f Phone------------------------------------ <br /> Address------ = ---------- ------ <br /> -- 7 <br /> Contractor's Name--- Phone. v� <br /> Installation will serve: Residence rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: j--.- Number of bedrooms ----I.- Number of baths __/--- Lot size ----- s..--------------------- <br /> Water <br /> ................. ..Water Supply: Public system ❑ Community system ❑ Private 4 -B pth to Water Table 4J_ ft. <br /> Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe pan ❑ <br /> Previous Application Made. Yes ❑ Noew 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 /> t <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------.-----Material------------------------------------------------- <br /> r _--.--.Liquid <br /> No. of compartments--- -------- - ------Size-----...---------------- q depth.-------------------------Capacity----------------------- <br /> ispo�sal Field: Distance from nearest well./f....-.---Distance from foundation.--,/__-....Distance to nearest lot lire.-Y.6-___-_ �~ <br /> Number of lines-_____-_�_...._ Length of each line..--_ -__.__ E Width of trench--------}��_______________•_.. <br /> Type or filter materiaL� ---------------Depth of filter material----.-/_/3----__---Total length--__-----f_-_----------------...._-.- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.D-sstance to nearest lot line--_-_------._--- <br /> L] Number of pits----------------------Lining material----------------------.Size: Diameter----..-----------------Depth--------------------------------- <br /> ( Cesspool: Distance from nearest well-----------------Distance from foundation_-------------------Lining material__-____.-____------.--_-._--____-----. <br /> ❑ Size: Diameter------------------ -N---------'------Depth-.------------ -------------------------------------Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well-______-----------------------------------------Distance from nearest building---____--_._-.--_-__-______.._.__..____. <br /> ❑ Distance to nearest lot line----------------- - --------- ---------------------•-----------...-----------------------------------.--_----------------- <br /> Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------- <br /> -----------------------------------------------------1----- --••- <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 /> ordinance%S-J�ofelars, les a d regulations f the San Joaquin Local Health District. w(Signed).__ -------�- --------- --- Co forBy ---•----- --- .�^r� ------------•------------------------------------------(Title).- <br /> (Plot(Plot <br /> 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 /> APPLICATIONACCEPTED BY------ -------- --- --- --- ---------------------------------------------------------------- DATE------ ------------------------ <br /> REVIEWED BY -------------------------- DATE------ } ------------------------ <br /> BUILDINGPERMIT ISSUED------------_---------- ------ ---------------------------- DATE. ---- -- J---------- ------_--------- <br /> Alterations and/or recommendations------------- ----- -- ----- --------------------------- ------------•-------------------------------------•------------------Is------.---------------- <br /> - --•-------------------------------------------------------------------------------------------------- --------------------------------------- -------------- •---------------- --- <br /> FINALINSPECTION 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 /> E_=2M 145446 ATWOOD 12-54 <br />