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;7 <br /> APPLICATION FOR SANITATION' PERMIT 44j `It No. <br /> (Complete in Duplicate) <br /> 7! /°3 clate Issued --- <br /> ---------- <br /> Applica-�ion is hereby made to the Son Joaquin Local Health District for a permit to construct an install the work herein described. <br /> This <br /> i I' nce with County Ordinance N 549 <br /> application is made P� <br /> -2- <br /> JOB ADDRESS AND ATION.. � - ------ ------------ ---------- <br /> t_f ----------!�-------- --- ------51------------- <br /> Owner's Name.---------------- --- ------ - --- -------- ---- -- ------ - -- ---- . ....... ------ ----------- ---------------- Phone------------------------------------ <br /> ---------------------------------------­---------------------------- ------------------------------- <br /> -- -- -- - .fit-`.l-4Contractor's Name._- --------- ---------------------------------- ------- -- -- ----- ------------------- ------------------------------------------ Phon�*W_!-24_1---- <br /> Installation will serve: Residence 4-7T—rarfmenf House ommercial E] Tr Court [] Motel Ej Other Ej <br /> Number of living units: _/---- Number of bedroo umber of bath6/---Jot size ---41-157---A---.20 7------------------ <br /> Water Supply: Public system El Community system [] Private�6pth to" ater Table 0/0 ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay F] Adobe %Lj�ardpan [3 <br /> 4. <br /> Previous Application Made: Yes F-1 No A---New Construction: Yes L-i 770-Ti- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> Septic Tank: Distance from nearest we;l-�Q_',...Distance from foundation------4f Mafer)al--_ -- <br /> rn ---------- <br /> 1p --- ----- <br /> No. of copartments........1 ______...Size ---- IV_:q_._Liquid clep�h----Ll---�c--- ---- ,pacaci - --- - ----------- <br /> Disposal Field- Distance from nearest we]---\51-0 I...Distance from foundation-----Vol ' tante to nearest lot line._-_--------- <br /> Number of lines..._-.-........_ <br /> .11-------Length of each line----/Zl!V idth of ------------------ <br /> Type of filter material--- -------------Depth of filter material..._.9, 7----------Total lengfh---- ---------------------- <br /> Seepage Pit: Distance to nearest well-.%--_A-a..... DistanceArom foundation-----Jbt!.Disfance to nearest lot line--- ---------- <br /> Number of pits------I------------- Lining maternal_ ...Size: Diameter_ Depth..__ <br /> --- -- <br /> ------ ------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------ -- --------- Lining material._..----------------..._._...------- I <br /> El Size: Diameter------------- Depth----------------------------------------------------Li uid Capacity----------------------------gals. C. <br /> Privy: Distance from nearest well..... - -- --------------------------------------Distance from nearest building_..__-...-.-----_-._-...__.--____-.-----. <br /> ❑ Distance <br /> uilding------------------------------------------ <br /> Disfanceto nearest lot line . .....---------------------------------------------------------------------- ------------------------------------------ <br /> Remodeling and/or repairing (describe}:--------- ------- ----------------- ------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------I----11------­----------I--------------------------------------------------------------­_­---------------------------------------------I--------------------------------------------- <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, Sf"atelaw and rules and r gulaflons of the San Joaquin Local Health District. <br /> U", <br /> g <br /> (Signed) ---- - I ------ <br /> )__I ---- __6__ -_._4-1, ____ _ ----------- ------------------------------------------------ --------- ontracfor) <br /> ---6 1------- ------- <br /> BY� <br /> ------ -­------ ---- <br /> 9� - ---------------------------------------------(Title}- ------------------------------------- ----------------- <br /> (Plot 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 /> APPLICATION ACCEPTED BY. <br /> BY-- --------------- --- ---- - ----- ------ ------ ------------------------- DATE_- <br /> REVIEWED BY----------------------------------- <br /> DAT ------ ��--------- <br /> .. ....... . �S <br /> BUILDING PERMIT ISSUED-------------------------- -------- ----------------------------------------------------- --------- DAT --------- --- <br /> Alterations and/or recommendations:------- .. .... -------- - --- -------------------------------------------------------------------------- ----------- -------------------- <br /> I <br /> ----------------------------------------------------------------------------------------- ---------------------------------------- ----------­------------------------------------------ __­�---------------------- <br /> ------------------------------------------------------------------------ ------------------ ------- -------------------------------------- ------ --------------------------------------------------- 4 <br /> ------------------------------------ - - -----•------------- ---------------------------------------------------------------------- --------------------------- ----------------------------------------------------- <br /> ------------------------------------- -------------------------------------­--------------------- ---------------------------------------------------------- ----------------------------------------------------- <br /> FINAL INSPECTION Date,_49— )/- <br /> ---- <br /> ------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Arnaricen Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5---9-2M 149446 ATWOOD llll,12«54 <br />