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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) f <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. 544. <br /> JOB ADDRESS AND LOCATION---------Lot---13_,---- akr�dge__D strict,__-�-�:-_corner_.of___Caran_ Rd-___------ <br /> Pte I . Kasta <br /> ----------- Phone-- �s412$-------------- <br /> Owner's Name------------------------------------------- - -- _ _ <br /> Address----------------------------------------------------- ----------------------------------------------------------------------------------- <br /> Pone16Q7 <br /> Contractor's Name--------------------------------- AING--------------------- ------- <br /> Installation will serve: Residence =Apartment House ❑ Commercial F] Trailer Court El Motel [:] Other [INumber of living units: JUI Number of bedrooms 5 Number of baths EL Lot size----100IXL2$=---__-_-_----------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [X <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [X Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well- 50tDistance from foundation----101__-____.Material r_-_----�i---C---�Brj-eek-------------- <br /> 20 No. of compartments--------Z-------------Capacity---940-_{ia-.a6'ize--56---X3-&X.63_tiquid depth---59 --------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> 171 Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> ;Privy: Distance from nearest well-------------------------------------------------Distance from nearest building"_"_______________________________________ <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> 'Seepage Pit: Distance to nearest well_ -----------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth----------------------- ------ <br /> Disposal Field: Distance from nearest well----�3Q1------Distance from foundation ___ �________Distance to nearest lot 4=ne_____ _________ <br /> Number of lines-------L------------ -----------Length,of each line__ d�___ 04--------Width of.french----_��#-------__-=---:-=_-- <br /> Type of filter material--I-P---Rk----Depth of filter mate a__------------_1811 ) <br /> Remodeling and/or repairing (describe):--------Ike-W---Inst-allot_ on.1 - -------------••-------------------------------------------------------------------------- <br /> ----------••------------------------------------------------------------- ----------------------------------------------- <br /> ---------------------------------------- <br /> ------- - ----•-----------------------------------------------•---------------------- -------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this applic ion and that the work will be done in accordance with San Joaquin County <br /> ordinances tate laws, and r nd` regulat s o e San Joaquin Local Health District. <br /> G D A* H SS. SNC.-------------=........... <br /> ----- •............... <br /> ----------" .....-------"" '......---------' � Contractor) <br /> (Sign -y.- ----! -------+--- -- =----- ----------------------------- -------------.---must b sled with -------•---- ------------- { <br /> By._ --[Title) E�tiIIA t�2T <br /> (Plot p �1ze of la , location of syste lation to wells, buildings, etc., e f this application). <br /> FOR DEPARTMENT USE ONLY <br /> ------------ <br /> APPLICATION ACCEPTED BY DATE----------- ---- -------------------- <br /> v_--- ----- DATE---------- -- = -/ <br /> REVIEWEDBY-----------------------------•---------------- -------------- - -------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------ ----------------------- DATE----------------------------------------------------- <br /> Alterations and/or recommendations-------------------------- --- -- ----------------------------------••-------------------------------------------- <br /> -----------------------------------------=-------------------------------- <br /> -------------------------------•------------------------••---------------------------------------- <br /> -------------- <br /> ISSUED J� ' [Date AL INSPECTION BY:------- �" ------------------------------ <br /> Date <br /> PERMIT No __ ` <br /> -- -- - <br /> �f ---------------------- <br /> Date-------------------------------- - ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-4-2M 9-50 W=1639 <br />