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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) / <br /> l� Date Issued <br /> Applica4-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------- _'/-- `�' ------- ,- ------[`---�-n------ -_-�--�-- Z,} <br /> Owner's Name------------------- `---•_ki <br /> � - Phone - <br /> 11A <br /> ddress ,.. <br /> � .�.ra. <br /> - 3 <br /> 1 <br /> Contractor's Name--•-•-----------------••----- ... ` ------------------------- -------------------------------------------- Phone--------------------;-------r <br /> Installation will serve: ResidencApartment House ❑ Commercial ❑ Trailer Court El Motel ❑ Other [I �c <br /> Number of living units: ___j--- Number of bedrooms___ Number of baths .Ir:7i 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 LoamLN�_Clay Loam` Clay ❑ Adobe,T Hardpan ❑ l <br /> Previous Application Made: Yes ❑ No)&- New Construction: Yes lfo I'D w 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: "' I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 felt.) <br /> Septic Tank: Distance from nearest well_2UA& <br /> � fI�stance from foundation__I- ---------Material- <br /> -___Liquid de th__.-___ _ _____Ca aci ------------ <br /> ,Disposal' <br /> C�_ <br /> No. of compartments---'----- ------------Size._1� r,-- - q P. P ty--- t <br /> may, q ------------- <br /> Disposal' Field: Distance from nearest well__l�Q�l�E istance from toundati _A � Distance to nearest lot line_______..... <br /> ------------ <br /> Number.of lines_____ _�_.-_Length of each line____ __ -_.__�s _a.�__.Width of trench--------- .____---_-- <br /> Type of filter material__A07A ......Depth of filter material-__._____$2__ __Total length-_------- -- __•- <br /> Seepage Pit: Distance to nearest well`1 -______Distance from foundation___, o_'_'.___.Distance to nearest lot line--.-- <br /> ine__._s_--____. <br /> 19 Number of pits-------a------------Lining material_-�_ a.5ize: Diameter_ -3_3 =___ __ -- ------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------_______________________________1IJ <br /> Size: Diameter-------------- ----De th-----:--------------- ------ ----- ------- --------Liquid Capacity gals._j <br /> Privy: Distance from nearest well--------------------------------._.--------------Distance from nearest building-----.-___.y.________________.._________. <br /> [❑ Distance to nearest lot kne-------------------------- --- ------`------------------------•-•------":•------•--------------------------------=I---------------- f <br /> Remodeling and/or repairing (describe)--------- ----------- .....................= ----------•--•------------------------------------------------------------ <br /> - . : <br /> ------------------------------------------------------------------------------------- ---y------------------•----•--•---------------------------- ­­----------------------------------- <br /> -------------------•-------- ........_-------------------------- <br /> Ir _... � <br /> --------------------------•----- ------------ ------•---------------------•---------- ------ -••--------------- ------- --... - '= <br /> --------------------------------------------------•-----------•---------------------------------------------------------....... <br /> I hereby certify that I have prepared this aplication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law , and r les and regultini'of the San J aquin Local Health District. <br /> (Signed)----� .._ .. - ------ ---------- -- ------ (Owner and/or Contractor) <br /> , <br /> 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--------- -- - -------------- t <br /> REVIEWED BY DATE /9 J <br /> BUILDINGPERMIT ISSUED------------------- ------------ ----------------------------------------------------------------- DATE------ ---------------------------------------------- --- <br /> A{terations and/or recommendations: <br /> ------------------------------------ - -- --------------------- <br /> -------------------- -------------------------------------------- <br /> --- ------ ` <br /> _ - <br /> x <br /> 4 •W - ___ _____ .... ____ .____.- _ _____.__. - <br /> ---- Z_ i <br /> ---------------------------------------------�- - - ------ I------- :---- -------------------------------- ------ -•-------..--..__..--.----------•--------- <br /> FINALINSPECTION. B5--------------------------- --------------------------- Date f SJ ----------------------------------- <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-9-2M 145446 ATWOOD 12.54 <br />