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7 � <br /> APPLICATI(PN FOR SANITATION PERMIT Permit No. <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 in-A-all-the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOBADDRESS AN OCATION L---- - ------- -- ------------------------------------------------------------------------------- <br /> Owner's Nam ...... .. ..........'--_ —- <br /> 0 <br /> - - ------- ---- - ------------------------- -- ----- Phone...._.._..---••-------------..... <br /> Address <br /> Contractor's Name r.( i�. �r----------•---- -----------••-•---------------•------------- Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/___ Number of bedrooms __�7 Number of baths ____L_ Lot size ---- <br /> Water <br /> Water Supply: Public system ( I Community system ❑ Private ❑ Depth to Water Tablevfv f+. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0\ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No rul <br /> YX <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€I_,,4/471+i—_Distance from foundation------ D_._r <br /> ------Material_1-��_____________________.___ <br /> No. of compartments--------,r.'Z_-------------Size------ 1__ -_X- �____Liquid depth-------- <br /> -----Capacity 9 D <br /> Disposal Field: Distance from nearest well....A/.17i�Distance from foundation----10. (.........Distance to nearest lot line-----0__/--- <br /> Number of lines--------------�._ - Length of each line_.___ <br /> en L - �. <br /> nn g ��------Width of trench----�'��-'-r- ---------- <br /> Type of filter material------ ___fLaYI(�epth of filter material-_-...1�--------Total length--------- _. --------_-__-_-_—__-•____ <br /> Seepage Pit: Distance to nearest well......f hVt'-Distance from foundation___rRd_- <br /> Distan� to nearest lot line----- <br /> Number of pits-----.-I-------------Lining material---C---._a 44 e: Diameter-_-_,Z_-1......----Depth_____ s;�7------------- <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 Distance to nearest lot line.-------- ------ <br /> Remodeling and/or repairing (describe):------------------------------------ ------------------------------------••------------------- ------------ .-----------•----------•-- <br /> -------------------------------•------------------------------•--------•--------------------•-----------------------••----------------------------------••---•-------------------------------••------------------------------- <br /> ---------------------------•-------------------------------------------------------------------------------•--•---------------------•-------•----------------------------•---•-------------------------•--------------------- <br /> ----------------------------------------------------------------------•---------------•---.-----------------------------------------.-------------------------- --------------------------•----------------------------------- <br /> I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat a , and rules and regulations of the San Joaquin Local Health District. <br /> (Owner and/or Contractor <br /> (Signed) ----•--- --- - ------------------------------------------ ---------------- -------- <br /> -----------•------------------(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 /> - <br /> --- -------------------------------- T <br /> REVIEWEDBY------------------------------------------- --------- - -- --- ------------------ -------------------------------- DATE_---- ---- <br /> BUILDING PERMIT ISSUED-------------- ---------- ------ DATE------------- ----•------ ------------------------ <br /> Alterations and/or recommendations--- ------------- ---------- .------------------------------------------------------------------- •-------- ---------- <br /> - ------------ <br /> ---------------------------------•------- <br /> -------------------------------------------- <br /> ------------ <br /> --------------------- --------------------------------------------------- -------------------------------------------- --------------------------.------------------------ ---------------------------------•------- <br /> FINAL INSPECTION BY:---- ----------- •------------ --- Date---------- --Jr--------------- ----- -----•--- <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 /> ES-9—ZM 14S44G ATWOOD 12-sn <br /> j <br />