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1 APPLICATION FOR SANITATION PERMIT Permit No. .- 6,.Z..-,/r_ <br /> (Complete in Duplicate) <br /> Date Issued -_�` -9 --- <br /> A <br /> Thippliceion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> s application is made in compliance with CJ'ounty Ordinance No. 549. <br /> /57 <br /> �a3 1 . <br /> JOB ADDRESS A LOCATION._--.--- <br /> ---- ------- <br /> JOB <br /> Name------- -- •. <br /> ---------------------•-------------------- <br /> / <br /> Address. --- --. - Phone--------------------- - - <br /> �✓ <br /> Contractor's Name---_--- e�.� <br /> ---------- <br /> ------------- <br /> Phon <br /> =urs <br /> Installation will serve: ; Residence artt ent House ❑ Commercial ❑ Trailer Court ❑ Motel <br /> ' -• El Other ❑ <br /> Number of living units: -- -- Number of bedrooms _-- Number of baths .- "_"_ Lot size __-- <br /> ----X .1.�-1,� <br /> Wafer Supply: Public system Community system ❑ Private (:j Depth to Water Table 1 yff. <br /> ----------- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �a,.dpan <br /> I <br /> ' �., � ❑ <br /> Previous-Application-Made:-Yes`❑ No �iVew Consfruction:'Yes NZ -❑ " ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank-or-cesspool permifted-if public sewer is available within 200 feet.) 1 <br /> Septic Tank: Distance from nearest well--.Distance from foundation-_- e ---"_-.Mat/r+ai-_ ---_-._ <br /> - - <br /> No. of compartments...-."., -------------_Size_-,,F-C--A-"q-0---_Liquid dep+h----�-2C-------___ Capacity 9 <br /> Field: Distance from nearest we11_ __Distance from founda#ion-----_V_____-Distance to nearest lot line_-_-S^.-_-__ <br /> Disposal __ Number of lines--- . Length. of each line_---_-.-_ .-_��_--_---"--Width of trench---.-'�_ <br /> '. <br /> Type or filter material-----/-�-----------Depth of filter material---_-�- <br /> p� f. <br /> Total length- {}--Q-- ----------------- <br /> Seepage Pit: Distance to nea est well---___..-- "---.-_ -Distance from foundation-------------------.Distance.to nearest lot line--._-""--_.-----_ <br /> f j <br /> ❑ Number of pits------------------ --Lining material----------------:-__--Size: Diameter-_----------_- <br /> € �..,� . € --------------------Depth--------------------------------- <br /> Cesspool: Distance.from,nearest well----------- <br /> ------Distance from foundation--------------------Lining material_. __.__-_---__._ '"4- <br /> 19^ ❑ Size: Diameter. Depth-.- -------------------- ------------ ----Li Liquid Capacity-.q p tY- --------------------------gals. \ <br /> r- Privy: Distance from nearest well-----_.."--.-_ -...__"-...._- Dis#ante from nearest building <br /> ----------- <br /> -f - 9 <br /> ❑ Distance`ta'nearest lot line"...---..---_#------------------------------_.-- --- ' <br /> Remodeling and/or repairing (describe):----- __---_-----.---- <br /> ----------------- <br /> ---------­-------------•-------------------- -----------------:- -------------------------- ------ <br /> y ---------- <br /> ----------------------------- <br /> 7- <br /> ------------- <br /> -.-____-;----------------------"--__._.___--.-----__--__.-___--_._----_.-.--_----__-._._----.--__------------------------------------------------------------------- <br /> ----_---- _--._--_-__--.__._--.___-__---.-.-------_----------.__-- c <br /> +hereby certify that I have prepared this application and that the work will.be�done in accordance with San Joaquin County ! <br /> ordinances, S e laws, andAles les and regulations of the San Joaquin Local Health District. <br /> r <br /> s --- •--- ---jZ <br /> 4 <br /> (Signed)--- <br /> ---- -- -- ----- ----------�- <br /> or <br /> By:•----- r ontract <br /> ---------{Title_" -rZ----- <br /> (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------- ---------------- ------------------------------------------------------------ ------ DATE---- <br /> REVIEWED BY - ----------- -- DATE / <br /> BUILDING PERMIT ISSUED---------------------'- <br /> -- <br /> -- -- -------------- ------------------------------------------------- BATE--------- ------------------- -- �•- <br /> Alterations and/or recommendations--------------------"- <br /> FINAL INSPECTION BY:.---- N = Date-. .,,.�. . <br /> 3-..'`-�4. ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1 <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 /> E5-9--2M 14Sg46 ATWOOD 12-54 <br />