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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> ----------- <br /> k <br /> Appltca4-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 /> - ---- ---------- <br /> ---- ---- ------ ------------ <br /> JOB ADDRESS A TI ---- --------------------I--------------- --- ---------------------------------- <br /> Owner's Namve----- -- ------- --- -------- - -------------- ---------------- ----------------- Phone------------------------------------- <br /> K --------------------------------------------------------•-•------- ----------------------------------------------------------------- <br /> Address-4.6 ------j -------------- a------- - ­ ------ --------- <br /> Contractor's Name------- __—-------------------------------------------------------------------------------- ----------------- Phone----------------------------------- <br /> Installation will serve: Res-idence44-9k-partmerif House Ej Commercial [] Trailer Court [-I Motel [-] Other 0 <br /> Number of living units: Number of bedrooms Number of bafhsl!�t_ Lot size -------- ------------------------- <br /> Water Supply: Public system El. Community system E] Private 95--8"th to Water Table A/5- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam 0 Clay Loam E] Clay El Adobe 6_11.11r�pan E] <br /> A <br /> Previous Application Made: Yes F <br /> I No 6�ew Construction: Yes f oma[] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fan'k or cesspool permitted if public sewer is available within 200 feet.) <br /> t I A <br /> Distance from nearest well--. Distance,from foundafion___J_6_.11 11__.._.Material------/ic <br /> Septic Tank: or <br /> No. of compartments----- �2,_----------Si,e_j_X__12_A._,S---Liquid depth.... ...A— <br /> ..A——-_...______--Capacity__,--' --- ---------- <br /> D'ycposal Field: Distance from nearest well---7_,.5—..._Disfance from foundation---ID... ____._-Distance to nearest lot line-----1� <br /> Number of lines---:-------- Length of each line.....-7-0.................Viclfh of trench- --------------- <br /> r -7/------ .e- f <br /> Type OT filter -----------Depth of filter material_._.._.. ........Total length-_-. ___________9__D______ <br /> Seepage Pit: Distance to nearest well---- -- <br /> ----- ---------Distance from foundation--------------------Distance to nearqf1ot line. <br /> El Nu.mber of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--.------------ <br /> Cesspool: Distance from nearest well_________ from foundation--------------------Lining material-_.----__,_.-_---.--_-_--__-_-__._... <br /> Size: Diameter----4. ............................--Depth_- <br /> _Dept h---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well>f!------- -------- _____________________Distance from nearest building___._________,__________-____.__.______. <br /> ❑ <br /> uilding------------------------------------------ <br /> F-1 Distance to nearest lot-line--------------------- ------ ----------------------------------------------------------------------------------------------------------------- <br /> Remodelingand/of repairing (describe]----------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------6------------------------------------------------ --------------------------------------------------------------- <br /> ---------I------------------------------- <br /> -------------------------I-----------------------------------------:----------------------------- --------------------------------------------------------------------------------------------------------- ------------------------------------•------------ ------------------------------­--------------------------------------------------------- -------------------------------------------------------------------------------- - <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 /> b i <br /> , - ctor'{Signed)---------- -- --- --- -- -------- -------- --------- ------------------------(Owner and/or Contra <br /> By--......................... . --------------------------------------L---- --- -----------------------------------------------------(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---------------------------------------- ------------- ---- --- --------------------------------------------------------- DAT -1-------nt-- -------------------------------------- <br /> --- -- ---------1� <br /> BUILDINGPERMIT ISSUED.---------------------- ----- --- ------------------------------- --------------------------------- DATE..------- - ---- -------------------_------- <br /> Alterations and/or recommendations:-- ;I_ _ <br /> -- --------- ------- ---------------- -­-------------------------------------------------------------------- ------- - ----------------­------------ <br /> - ---- --- ---- ------------------it----------- ----- ------------ ------- ---- <br /> ------ --- ....... ----------- <br /> I-0----- ---- --- -- ----- <br /> ­--------------- <br /> ��<------------- -- ------------------ ---------- - -- <br /> -----------------------I-- -------- --------------------------------- ------------------------------------- - --------------- --------------------------------------------------- <br /> --- _;------------------------------------------------- -- <br /> - ------------ --------------------------------- - ------ --- -------------- - ----------------------------------- ---------- <br /> FINALINSPECTION BY:. . .......... --------- -------------------- Date----------------------- -- ------------------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street l 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca. California Tracy. California <br /> EE---9-2M 145446 ATWOOD I2-54 <br />