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WDA <br /> APPLICATION FOR SANITATION PERMIT Permit No. _.-. ----------------- <br /> (Complete in Duplicate 7r7�1 3 Z- �o/ <br /> Date Issued <br /> Applica+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 Cour4f.y� rdi�No. 549 <br /> JOB ADDRESS 'NJ) LOCATION . _ r <br /> Owner's Name �~ �,y <br /> �.'tt`�{--,�t ,_"---••----...�L--:-------= •J�`--•-------------------------- -------- ­--------------------------- -- - Phone------------------------------------ <br /> Address------ <br /> -----------------------------------Address-----• `'s ' ------------------------------------------------------------ <br /> Contractor's <br /> - ------- <br /> Contractor's Name ! . . -------------------------------- <br /> Phone-------------- <br /> Installation will serve: Residence Apartment Huse❑ Comercial ❑ Trailer Court ❑ �Mofel ❑ Other ❑ { <br /> Number of living units: _______ umber of bedrooms _____a_ Number,of bafhs __A__._ Lot size ______'��__ _ <br /> Water Supply: Public system Community system ❑- Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑Gravel ❑ ' Sandy LoVNo <br /> Clay Loam [jClay E] 'Adobe rLe(Hardpan E]Previous Application Made: Yes ❑ No R/ New Construction: Yes ❑ <br /> F � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feett� <br /> Septi Tank: Distance from nearest well_ *+________Distance fro,�nffo ncation_ .___-.____..Material_________________ "'" -F__._____._. <br /> No. of compartments--___....�------------Size_AP _�►�___.___Liquid depth_.._______ ____-___..Capacity_.___ _ f <br /> Dispos field: Distance from nearest well---.*. _____ _Distance from foundation -z.Disfance to nearest lot liner <br /> Number o7 lines___._-____ -_ Length of each line______ <br /> r Width of trench - ' <br /> �S.- ? <br /> Type of filter materi _� Depth of filter material____..._,h_ _ Total length_________________f _ _y____�__ <br /> r <br /> Seepa Pit: Distance #o arest well----�---K-•- - Distance om .foundati�r .a.rstan to,nearest lot line <br /> } i Num cf pits------- _,r"___Lining ma# r _ IsSize: Diam Depth_ rf .----------- <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------------------------------_---__--___. V <br /> ❑ Distance to nearest lot line---------------------------- -------------� ------- •----------------------•-------------------------------------------- <br /> Remodafing anjf�J�`l/•r repairing d---Xi -_At_ - -- -- -� "•�{. ` _ ((�`._�►__.:_~. _. _ <br /> , --•• • n { ------------- <br /> I hereby certify that l have prepared this application and that the work will be done in accordance wif4an Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> �� <br /> (Signed) 'J = Owner and <br /> 9 )-------- /or Contractorl <br /> �i� Title <br /> (Plot plan, showing size of lot, location of system in relate n to wells, buildings, etc., can be placed on reverse side). <br /> c s <br /> FOR DEPARTMENT USE ONLY 441 42 <br /> APPLICATION ACCEPTED BY- - A"..�,�_�J�-�Z l- --�-------------- DATE --------•-------------------- <br /> REVIEWEDBY-------------------------------- -- - DATE_. -�------------------------------------•---••--------- <br /> 811lLDlNG PERMIT ISSUED ------------------------ ----------------------------- DATE-----" -------------- <br /> Alterations and/or recommendations------------------ --------------------------------------------------------••-•--------------------------�"`-------•-------•---- ------•------------------- <br /> ------------------------------------------------ T <br /> ,r 1 <br /> ��,nt.a `° lJ., '----:y _[�!°�!!� - �b9k d'`� -- ---------------••-----• <br /> .P 4 <br /> FINAL INSPECTION BY:-? ---------------•------- '----------------- - ------------ Date--- <br /> tried -------------------- ----------------------------- <br /> t ,4.~,"a SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r <br /> 30 ou h American Stree'f �, 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-2M 145445 ATWDDa 12-54 1 <br />