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Permit No. <br /> APPLICATION FOR SANITATION PERMIT - --------------- <br /> (Complete in Duplicate) Date Issued ... <br /> Applical-ion is hereby made to the Son Joaquin Local Health District for a permit to construct 7a -_'"a[I Ihe4in described. <br /> T is-application is made in compliance with County Ordinance No. 5 <br /> 4. <br /> .2 t <br /> L C, - ----------- ---- . . .............. <br /> -33 1/ —----------r-'- <br /> Phone------------------------------------ADDRESS AND ON 4t -- ------­A--V:?s- ---------- ----- - <br /> .0 Phone------------------------------------ <br /> Owner's Name-----------L---- - -------------- - ------ ------ ------ <br /> ------------------------------------------------------- <br /> Address-....------------------------------------ - ------- ----- ------------- - <br /> Phone--------- M--------------- <br /> --------=- --------------------------- V <br /> Contractor's Name------------------------- _t <br /> Installation will serve: Residence Apartment House 0 Commercial E] Trailer Court E] Motel [I Other El <br /> -l-ea �rt <br /> Number of living units: /---- Number of bedrooms 3... Number of baths. -Z.-- Lot size - --X"5 ------------------------- <br /> Water Supply: Public system El Community system El Private [Bepth to Water Table K_/Pff. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam ERl-Clay Loam 0 Clay El Adobe C3 Hardpan E3 <br /> Previous Application Made: Yes 0 No ErNew Construction:11 Yes No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public I sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__��--------Distance from f on---14---------Material-----C ------------------ <br /> 51-------- --------Capacity----- <br /> No. of compartments---.-.. Size ---------------Liquid Liquid cleptk--- <br /> ------ <br /> _.____.--Distance to nearest lot line--- <br /> 01PDisposal Field: Distance from nearest well Distance from f""n' S <br /> A4 -------- <br /> - __�Viclth of trench._;_2_�" <br /> N lines ri ne-_6_ 7------------- <br /> umber of --------------A---------------Length of each <br /> Type of filter material.-- __-R4_Lc_J<____Dep+h of filter material "__------_Total length----- <br /> Seepage Pit: Distance to nearest well- - ------------------Distance from foundation-------------------Distance to nearest lot line <br /> ElNumber of pits------- - -----------Lining material---------- ------- Size: Diameter------: --------Depth--------- - --------------------- <br /> Cesspool: Distance from nearest well______.__." -- Distance from foundation....................Lining material.-_-_____..____.__.--_-__.________- - gg <br /> Size. Diameter-------- ------------- -------------- Depth----------------------------------------------------Liquid Capacity--------------------------gals. <br /> ❑ <br /> Privy: Distance from nearest wO- ------------_----------- ------------------ --Distance from nearest building_.___________.___-..--___-___..____--_._. <br /> Distanceto nearest lot line-------------------------------- ---------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):----------------- -------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------­-------------I-----------------------------------------I----------------------------------------------------------------------- ----------------------------------------------I----------------------- <br /> ---------- <br /> ------------------------------ ---------------------------- ------•--------------------------------------------•--------- ----------I--------- <br /> ----------------------------------- ------------------------ ------------------------------------------------------------- ----------- <br /> -------- --------- - - ----- ---- <br /> -------- <br /> - <br /> ­I hereby..certify that I have­prepared- - -..this__application­and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, ae rules and regulations of the San Joaquin Local Health District. tO <br /> (Signed)_ e- - - -.-- g!�r Contractor) <br /> By:-------_--------------------- --------------- ---------------- ------------------------ ---- <br /> -------------7--------------------------------------------(Title)---------------------------------------------------------------- <br /> sIlhowing size of lot, location of system in. relation to wells, buildings, etc., can be placed on.reverse..side). <br /> F9 <br /> fIVIENT U�SENLYG <br /> 'ET <br /> AT[ ------------------------ <br /> APPLICATION ACCEPTED BY____... <br /> DATE---------------- -------------------------------- <br /> REVIEWEDBY----------------------------------- ------- -------------------------- ----------- ---------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------- ----------------------------------------------- DATE--------•---------- <br /> Alterations <br /> ATE-------------------Alterations and/or recommendations:__.-_._.__________________ ----------------------------------------- <br /> --------------------------7----------------- <br /> --------------------------------------------------- -------------------------------------------------- .........................I----------------I-----------11,------------------------------------------------------------ <br /> ----------L---------------------------------------------------- -------------- -------- ----------- ------------------------------------------------------------------­­------------------------------------- <br /> --------- -------------------------------I--­----------------------------- ----- --------------- ------------- -------------- ----------- ----------------- ------------------------------------------------- ------------ <br /> --------------------------------- ------------------ ----------------------------------------------------------- ---------------------------------------- ------------------------------- <br /> ------------------ <br /> FINAL INSPECTION BY----- ---- ------------- ------------- Date----- -------- ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 13?,sycamore Street 814 North "C" Street <br /> "A Stockton, California Lodi, California Manteca,'California Tracy, California <br /> ",71 x-,•145446 ATWOOD 12-54 <br />