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oV <br /> APPLICATION FOR SANITATION PERMIT Permit.No. <br /> (Complete in Duplicate) Date Issued - � •--• ` <br /> WA <br /> Applicaa-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the works herein described. <br /> This application is made in compliance with County Ord' e No. 549. <br /> (I(J-� --- . . <br /> ---------------------- <br /> JOB ADDRESS AND OCATION------------ <br /> Phone-------- --------------------------- <br /> CA <br /> ---------------------•---- I <br /> Owner's Name------- --- ----•----- ---- - <br /> -- l <br /> --------------------------------------------------•----------•--- <br /> Address--_•.--••--4-I-�.._r— <br /> ----------------------------------------------- ------------------------------ Phone.-------•------------------------•- <br /> Contractor's Name---------------- ----------- ------------ <br /> Installation will serve: Residence partment House ❑ C mmercial [] Trailer Court ❑! Motel ❑ Other ❑ <br /> �� 0/6-0------------------------ ------ <br /> Number of living units: ---[ Number of bedrooms ---__ Number of baths _--�___ Lot size•____ ___._ <br /> Water Supply: Public system' Community system ❑ Private ❑ Depth to Water Table __ �e ft. <br /> E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ fClay [ICharacter of sail to a depth of 3 feet: Sand Adobe ` Hardpan ❑� ' <br /> Previous Application Made: Yes ❑ � No '1l New Construction: Yes ❑ 'Nov, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No sept tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--------------_-Distance from foundation___________________Materia.__-______.._____.___._-_____..._.__________.... <br /> No. of compartments Size -..Liquid depth--------------- ------_Capacity----------------------- <br /> ____________.-Distance from foundation__:_____....___._._.Distance to nearest lot line----------------- <br /> Disposal Fjel Distance from nearest well__ <br /> umber of lines------------------ ------- - - Length-Len of each line-----------------------.-- Width of trench----------------------------------- <br /> - <br /> g --- <br /> 1 Type of filter material----..-.__--------------Depth of filter material-----------------------T�tal length_----------------------------- ----------- <br /> Seepage Pit: Disfiance to nearest well------��`---Distance fro founds ion /.Dista ce to nearest lot line_____ <br /> Linin material- _ -. -- : Diameter_-1pXZ-- -----Depth------ <br /> ----- ,f---- <br /> 1 Number of pits----------- ---- - g \ <br /> Cesspool: Distance from nearest well_________________Distance from foundation.__----____..._.--.Lining material.---_._________-._._________--$I5 ` <br /> ❑ Size: Diameter.---_------------- ------Dept h----------------------------- - -- -Liquid Capacity----------------------------g 9 <br /> ----------- <br /> Privy: Distance from nearest well--------------------------- - - -----Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot -------------------------------------- ------ <br /> ------------------------------ <br /> I <br /> Remodeling and/or repairing {describe} -------- --- ------------ ------------=---•--------------•----------------------------------------------------------- <br /> --- <br /> -----------•------------------------•------..------ ------ —. <br /> 1 <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, and rules and regulations of the San Joaquin Local Health District. <br /> ' <br /> • :(Signed).:-- -- - ._ -- -- ---------- -------- <br /> - ---- _.:.__-----(Owner and/or Contractor) <br /> --------------- ------- <br /> - <br /> 1� s <br /> -------- -- ---- ---•-----•--------•�-------(Title)--------------------------------------------- --------- <br /> By:------_------------------------------ ----------------- <br /> (Plot <br /> ----- ------------------ - --------- - -- <br /> s (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 /> ------ ---- -------------- ------ DATE---------- ._ <br /> --------- -------- �� - -�-�-�- -�- - - ----- <br /> ------ ----- DATE------ .. <br /> REVIEWED <br /> BY DATE <br /> ------- .. F <br /> BUILPERMIT 155UED------------------------------ - -- <br /> Alterations and/or race menc�ations:-_-- Q� <br /> ------ ---VI-.,-- <br /> DING <br /> �. � "�--� •---r —------------------------------------------------------- <br /> ----------------------- <br /> ------------------------------------------------------------------------ -----------------------•--------------------------- <br /> ------------------------- -------------------------------- - <br /> ----------------------- <br /> 7�(jDate._._l/,.._ —5 --- ------------- <br /> hINAL INSPECTION BY:.--/.. :.._ ------- --- '" �--���---�------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C' Street <br /> 130 South American Street Trac California <br /> Stockton, California Lodi, California Manteca, Cornia Y• <br /> 1 �s-9-2M 1.....ATWOOD 12-54 jJ, <br />