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APPLICATION FOR SANITATION PERMIT Permit No. .._.�.--_.!____...__- <br /> (Complete in Duplicate) <br /> Date Issued .-.- <br /> Applica-lion 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 /> r 1y <br /> - .- - - --- { - •--"-``-'-�----�-- <br /> - <br /> JOB ADDRESS AND LOCATION � ___ O <br /> Owner's Name------------—Z -----------S�ti--- --•------------------- ---------------------------------------- Phone------------------------------------ <br /> Address ---------•--------------------------------------------------------------------------------------------------------------- -----­­------- <br /> Contractor's Name------------------------------- Y ,-------------------------- ----------------------------------------------------•---•--- Phone---------------------------------- <br /> Installation will serve: Residence Apartment House ❑' Commercial El Trailer Court El Mot ❑ Other [:1 <br /> Number of living units33r_-J-_ Number of bedrooms _ Number of baths'--/---- Lot <br /> . � size ----._-- _.T'{!_�" - <br /> ------------------ <br /> CommunitY system ❑ Priv;te Depth to Water Table 4S ft.Water SuPPIY� Public system. <br /> �- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cl 'y Loam ❑ Clay ❑ Adobe JN Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑7 New Construction: Yes ❑ No [S� <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 well--.---- - - Distance from foundation-------------------Material--.-_---_-_-.-________-.__-.___---_._._-...._-. <br /> ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well-----------__--Distance from foundation--------------------Distance to nearest lot line-__-___--- <br /> ❑ Number oT lines-----------------------------------Length of each line------------------------------Width of trench____ <br /> Type of filter material-------------------------Depth of filter material ___-____-_---_-----Total length-----.-_--------_-_-----_.__---.-_-_-----. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-_---_._-_.-_._. <br /> [] Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth___ <br /> Ce sp I: Distance from nearest well _el�_0_____Distance from foundion_-__1._0-_..--.Lining <br /> Size: Diameter- ' t ------.Depth---------�Q------- - - - - -------------Liquid Capacity /�f` gals. <br /> a <br /> Privy: Distance from nearest well-___-_-____..... ..............................Distance from nearest building-------------._-__.-----___--. <br /> ------------ <br /> ❑ Distance to nearest lot line-- ----- --------------------------- -----------•--•-•---------=--------•---------- ------------------------------------------------------- <br /> Remod ling n or repairin (describe) 1----- -•--------------- -c ----• -----•-•--•-�1� -.. �---------- -•--------------------•-•---------------------•--- <br /> -----•--------`----- - -------------•----- P ----_"'�' - f�---•------------ --------------------- ------------------------------•-------••------- ------------------ <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 /> --�---------------•-- ----------------------------------------------------Owner and/or Contractor] <br /> Y ---•------------------------(Title)---------------------------•------------------------------------ <br /> (Piot 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------- �j- <br /> REVIEWED BY--------------------------------------------- <br /> --- -`------ - ------------------ -- ----------------- DATE------- �-- =— 4t__.-J--------------------- <br /> . - <br /> BUILDINGPERMIT ISSUED------------------------- I --.._.. ------------------------------------------- --------- DATE-- --------------------------------------- <br /> Alterationsand/or recommendations:---------------- ------------------------------- -------------------•------------------------------•---------•-•--••-----•-•----------•------ <br /> L <br /> ----------------------•___•-----------------------------------.--_-----------.-------.---------------.------.-----------------------------..-------_-.-_-.__--_..._-----.------------------------------------------------------ <br /> --------- ------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY------------- ��:.� Date------------ --------------------------------------- <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-9-21M 145446 ATWOOD 12.54 <br />