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r <br /> APPLICATION FOR SANITATION PERMIT Permit No. -.7 <br /> Q_ <br /> (Complete in Duplicate) <br /> i <br /> Date Issued _._ <br /> Applica}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 OCATION.._.___ _ �fp <br /> La 7 <br /> - ------------- <br /> Owner's Name. 'tom- -[_ ---•-----•----------- <br /> �f' @ f-a_S.'s�i�,-----i-- r' --------- ------- Phon __ <br /> Address------------ --- • - ----------1_7X_,�-------•--"�D._e".-- --�-a -�„�� <br /> - <br /> Name_----------•--- _ iC .. _ <br /> �}► <br /> Installafion will serve: Residencef <br /> �Apartmen} House ❑ Commercial ❑ Trailer Court ❑ <br /> Number of living units:-0--- Number of bedrooms Motel [-] Other ❑ <br /> ---. Number of baths -2---tot size -----4-0 <br /> Water Supply. Public system �sox'.4--- ................. <br /> Character of soil to a depth of 3 feet: ---- <br /> PP .Y' mmunifiy system ❑ Private ❑ Depth to Water Table --- ft. <br /> ft. <br /> Sand ❑ . Gravel ❑ Sandy Loam ❑ Clay Loam ❑ C!a <br /> Previous Application Made: Yes ❑ No Er--;`New Construction: Yes El No <br /> per Y El Adobeardpan E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tek: Distance from nearest welJ!p&e__Distance from foundafi n_� r_ �t <br /> ---- -------- Ma erial------- -------------- <br /> No. of compartments----.�e._ ---------------Size � ` rC •. �----- ----.. <br /> j-•- -----?- Liquid depth._, -- <br /> Disposal Field: Distance from nearest well - r Capacity_ O,O �. <br /> bti __-Distance from foundation•-`- --__-----Distance to nearest lot line___..__...'-'1- <br /> �}� Number of lines_ -"__"- ----_" -_--_Length of each line_ <br /> ��,�,�� g� g �e�"------40-"---.Width of trench_.+Z_.�`� i <br /> Type of fitter material-�`-f;VC__je-=)-Depth of filter material____./.�-��-"----Total length_____,L1�0-0--------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation ______.__ <br /> Number _..Distance to nearest lot line_________________ <br /> ❑ Number of pits______________________Lining material__._---_______-- -----.Size: Diameter__..--" - <br /> Cesspool: Distance from nearest well-----------------Distance from foundation._.._-_____.._-____.Lining material___.____.___--._____._-""_---------- <br /> -------------- <br /> ­: <br /> -_- <br /> ❑ Size: Diameter -------- ---------------- -------Depth---- -- <br /> v , , ---------Liquid Capacity --------------------------gals. (A <br /> �_ <br /> Privy: Distance from nearest well �"` ------- Dista ce from nearest buildin <br /> ------------ <br /> Distance to nearest lot line.--------•- g" ..............------ $ <br /> -------------- <br /> Remodeling and/or repairing {describe):--- -----• " ` <br /> _�------ <br /> --------C <br /> --•----•--•-----•--•--------------------------•---•-.----- ' <br /> ---------------"-•--------•-------------- ----------•-----•------------- ----------•--••-..---------------•---------•----••--•---------------•----------•-•--- --------------------------•----------.-- <br /> ------------- --------------- <br /> ----------- <br /> I <br /> -•--- <br /> -I------------------------- <br /> - e -• - ti -- I ------•--•---------------------------------•--------•-------------- --------------------•------•---------•-----•----------------•-- f <br /> I hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, laws, and rul s a d regulations of the. San Joaq n al Health District. <br /> 4 <br /> yy ' ff , <br /> Q" '5---------------- `' - ` -!Z , <br /> (Signed) { '-- ---- <br /> A <br /> By: ---•-----"--------------••---•---••---•-------- -- -- �------ <br /> (Plot /�f and/or Contract <br /> s�Cf _-(Owner d/o � <br /> plan, showing size of lot, location of sy in relation to wells, b ' ings, efc., can{bele laced on revers <br /> P e side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------- ----- <br /> DATE <br /> REVIEWED BY <br /> ------------------ - ---------- DATE------------------•----------- <br /> BUILDING PERMIT ISSUED--------------------------- - --------------------------------------- <br /> ----------------------------- <br /> - ------- --------- ---•-------••------ - --- ----•------------. DATE--- ----------------•---------- <br /> Alterations and/or recommendations___________________________ <br /> ----------------------------------------- ------------------ <br /> ------------------------------------------ <br /> FINAL INSPECTION BY:------- <br /> --- - --•--- • Date------- --- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 1; <br /> 130 South American Street 300 West Oak Street 132 Sycamore StreetI <br /> Stockton, California Lodi, 14 North C" Street IIII <br /> Californiaalifornia Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOOD 1Z-54 <br />