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1 APPLICATION FOR SANITATION PERMIT Permit No. __. ..__U._-------- <br /> (Complete in Duplicate) /a�3D <br /> Date Issued ---- <br /> I <br /> ___ <br /> Applica+ion is hereby made"to the San Joaquin Local Health District for a permit to construct and install the work herein described. i <br /> This application'is made in 1 mpliance with County Ordinance No. 549. <br /> ---------------- ' <br /> I JOB ADDRESS AND LOCATION------ 1 Q L ---------�a <br /> ----------- ----- --- <br /> Owner s Name---------------------�hJ <br /> -------------- Phone-------- --------------•------ <br /> Address ��w^^_ - - ------------------- <br /> - --- -------•- •------- ----------- <br /> Contractor's Name__________ ___ __ <br /> --- -------- <br /> Installation will serve: Residence partmen�us Com ercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living uniih: -1--- NumbeX:of bedrooms __ Number of baths -------- Lot size ______. � � �,-f.2----------------------- 4 <br /> Ar <br /> Water Supply: Public syste4Pmommunity system'❑ Private ❑ Depth to Water Table-NIP4— <br /> Character of soil to a deptI of 3 feet: Sand [-] Gravel ElSandy Loam ❑ Clay Loam ❑ Clay ElAdob,qCQ--I-lardpan L] ' <br /> Previous Application Mader Yes New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: w <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i <br /> Se tic Tank: �, Disfan ce from nearest well_________________Distance from foundation-_.__________-----Material____.___-__.___-_---.-------:-_----.-------- --• <br /> I Liquid depth - .---------Capacity <br /> . No. of icompartments------- ---- ----------5ize--------•------------------=-- q p. -------- ----------- <br /> Disposal Fie! :._... Distance from nearest well_________________Distance from foundation-------------------- to.nearost lot line..________-_--__. <br /> �^ Number of lines---------------- -------- --------Length of each line Width of trench <br /> Type of filter material- --------------------Depth of filter material_....____---_----.----Total length_---_________-___-_.-------_---------�•• <br /> IIII r <br /> �; �r <br /> Seepage Pit: Diu abe of ntsrest we e from foundation____.. D' tante to nearest lot line__.__.t_�_-. <br /> i p' Lining material_�7 _�_>...Size: Diameter-------- --------------Depth-------- --------- ----- <br /> Cesspool: Distant from nearest well_____-----------Distance from foundation--------------------Lining material-----------------I--------------------- <br /> Size: ameter---- --------------------------------Depth--------------------------------- ----------------Liquid Capacity-----------------------------gals. <br /> ❑ Distance from nearest well:_ "_.-Distance from nearest building------------------------------------------ <br /> Privy: �p -------------- <br /> ❑ Distance to nearest lot line-------- ---- ---------------------------- - <br /> ----------------------------------------- <br /> I Remodeling and/or-----r---e----p----a----i--i-@1-1ng---(--d----e---- <br /> describe):----- -� ----,---- ------------------------•-------•----------------------------•-----••----•---�---•-- <br /> q ------------------------------------------------------------------------------•-------------- <br /> ----------------------------=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 �d rules and regulations of the San Joaquin.Locai Health District. <br /> {Signed) m <br /> .��-: .�.�1 ---- nor-and or Contractor) <br /> .� _ . - - ;- <br /> ' '---- --- - ------ ---- --------- ------- e) <br /> -- -- - <br /> BY <br /> Plot Ian, showing size of lot�tion of sysfi n in relation fio ells, buildings, etc., can be placed an reverse side). <br /> ( P g �� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE------------ ------------------------ -----=---------- <br /> REVIEWED BY-----------------�f----------------- ------- ------ ------------ <br /> ----- --- -- <br /> DATE _.'..r�-'S-b ------------ <br /> BUILDING PERMIT ISSUED------------------- ----- ------------------------------- DATE.......... <br /> Alterati ns and or recommendations: - ---- - _ <br /> 44 C - <br /> kkr <br /> -- <br /> __.;-75= ---- <br /> Date. .--------•----------------- --------- <br /> FINAL INSPECTION BY--------- - -------- -- -- --- i----------- ------- � � ,. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 sycamore Street 814 North "G" Street <br /> Stockton, California' <br /> Lodi, California Manteca, California Tracy, California <br /> ES-9 145446 ATWOOD <br />