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APPLICATION FOR SANITATION PERMIT Permit No. .__._.�a---F.2, <br /> (Complete in Duplicate) ! <br /> Date Issued ----I1_t_�__�o <br /> Appiica}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 County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--- ----- -i. p . <br /> - ---- ---- - - - - - - <br /> Owner's Name 1.w�?� _•-- �J--------------------•------- ----- ----------------------- ---------- Phone <br /> Address-------------------------------- �../4L I! <br /> -- ----------------------------------- ----------------y <br /> ------------------------------------------------------- ----------------------------- <br /> Contractor's Name------- --- •-----------•--•----•---------- --------------------------------------------•- --- •------------•----•--- Phone ---------- <br /> Installation will serve: RlidenccK Apartment House ❑ Commercial ElTrailer Court ❑ Motel E] Other E]Number of living units: --j--- Number of bedrooms -Number of baths ----1. Lot size ---------- <br /> Water <br /> ________Water Supply: Public system ❑ Community system ❑ Private "Depth"to WaferTable�1 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No*_ New Construction: Yes V] No-��• _ - -•� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic <br /> ank = Distance from nearest well_________________Distance from foundation--------------------Material---------------.----___.__________________..__. <br /> No. of compartments------------- ------------Size-----•.-------------------------Liquid depth------------------------._Capacity-- -- ---------------- <br /> 4Disposal Field: D <br /> istancee from nearest well-j0-0-+Distance from foundation__,a-------Distance to nearest lot l' e. <br /> Number of lines--------- -- --- Length of each line--------- _.Width of trench._.49_�__.-___________ <br /> Type of filter material-___�-�_/4'W1@epth of filter material...... _ g <br /> _ Total length --•Z--C---------------------=---- � <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation_______________---Distance to nearest lot line___________._____ <br /> ❑ s Number of pits------ --------------Lining material-----------------------Size: Diameter------------------------Depth----_------------.•_------------- <br /> Cesspool: Distance from nearest well _____--------___Distance from foundation--------------------Lining material -__.____________.____._______.____.-. <br /> ❑ Size: Diameter--------------------------------------Depth-------------------------------------------:--------Liquid Capacity----------------------------gals, <br /> Privy: Distance from nearest well----.__-----------------------------------------Dista nce from nearest building----______.__.___.______-_-__-_-._.____._. / <br /> ❑ f Distance to nearest lot Iine------------------ -----------------------------------------------------I----`--- ---------------------------- <br /> Remodeling and/or repairing (describe):----------------------------------------------------------------------------- .......... <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> [Signed} -/ ------C.----- ---------------------------- -------------------------------------------------------------- --------(Owner and/or Contractor) <br /> By (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------------------------------------------------ - -•--------._...----------- DATE------------- -- � --------------- -- <br /> - <br /> REVIEWED BY -------------------------------------------- ----------------------- ----- --- - -------------------------- DATE----------- <br /> BUILDINGPERMIT ISSUED------------------------------- --------- -- --- - ----------------------------- ----•-• - DATE------ -------.---------------------------------------------- <br /> Alterations <br /> - .-----------------------------------------Alterations and/or recommendations:- ------ ----------- -------------------------------------------------------------------------------------------------------------------- <br /> -------•--------- --------------------------------------------------------------------------- -------------------------------------------------------------------------------------------•-------------------------------•-•- <br /> -------------------------------------­--------------------------------------------------------------------------------------------------------- --------..------------ ---------•--•---------------------------------------- <br /> FINAL INSPECTION BY:--------- - --------------------------- <br /> -'__-- -- --------- Date------- ----- .-� - <br /> ._._ �. <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 /> E5-9-2M 145446 ATWOUD 12.54 <br />