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APPLICATION FOR SANITATION PERMIT <br /> {Complete in Duplicate) <br /> t <br /> Application 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______ --- �01--------- <br /> Phone__Vg�_.z_/(0_ <br /> Owner's Name------------ ------ ------- - ------- --- ------Address------- --------------- ----- <br /> ------------------- Phone___92t__f__i(-_jP-7------- <br /> Contractor's Name-------------------------------- A_ 4AA <br /> Installation will serve: Residence F-[ Apartment House [X Commercial ❑ Trailer Court 0 Motel El Other El <br /> ............ <br /> Number of living units:j Number of bedrooms Dumber of baths.Z? Lot size- ------------------- <br /> Water Supply: Public system x Community system 0 Private E] Hardpan 0 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 17-1 Sandy Loam El Clay Loam 0 Clay E] Adobe <br /> ISS <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- 00 feet.) <br /> (No septic tank or cesspool permitted if public sewer is available within 2 <br /> e)tic alnk: Distance from nearest well-__--- Distance from foundation-- Material-------------------------------- -------------- <br /> 91,�i NO. of compartments__-_.______--------------Capacity_____------------------Size-------------------------------�Liquicl depth______------------------- <br /> r Lv-� Distance from foundation------------------- Lining material------------------------------------- <br /> .Cesspool., Distance from nearest well <br /> F1Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----______- ----------------------------- -a <br /> Distto nearest lot line------------------------------------------------ .0 <br /> M Distance rest we��Aokt_k----Distanc founj�af anon____167-!- <br /> Di tante to nearest lot line-----C5-------- <br /> Seepage Pit: Distance fo.nea _A ---- ----------------- <br /> Number of pits,-----------/---------Lining materiaa8robf1"Size: Diameter-—/,2_"___.Depth_A_J--_-` <br /> X- -from- ---0 ---- nearest lot line----15 <br /> -Disposal Field: Distance from nearest well-140KA__Mstance foundafion-7- -'--_Distance to " <br /> Number of lines-------j------L-41------------Length of each line----V-d ------ ---.Wid+h of trench___--_----------------------- <br /> 0ii <br /> Type of filter material-I 101- <br /> _ __.Depfh of filter material---------/0 ------ <br /> Remodeling and/or-repairing (describe)- -- - --&------------- ------- -----------­_.------------------------------------------ <br /> ----------------------------------- <br /> -------------------------------------------------------- h------ ................................................ <br /> --- ------------------------- --------t-------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <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 law,.pLanrules and regulat' ns of the an Joaquin Local Health District. <br /> 0 a ii--------pw� onfractor) <br /> (Signed).- 4--_ $_ __ <br /> - -- -------------------------- <br /> ---------------- <br /> ---------------- (Title <br /> By:------ ----------------------------------------e-I-Is,-b.u-i-ld-i-n-g-S, etc., mist be fi AedWith this application). <br /> (Plot plans, shl ing size of lot, location�?system in relation to w ------ <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------------------------------- <br /> APPLICATION ACCEPTED BY__C--------------------------------------------------------------------------------------------- DATE--- <br /> DATE--------------- - ---------ie-------------------------------------------- <br /> REVIEWED BY--------------------------------- ----- DA <br /> TE------------- <br /> BUILDING PERMIT ISSUED_______________ <br /> ---------------- <br /> ----- <br /> Alterations and/or recommendations:----------------------------------- -------------------------------- <br /> ----------------------- ------------------------ <br /> -------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -- ------------------------------ <br /> ------------------------------------------------------------ ---------------------------------------------------------------------------------------Y ------------------------- <br /> ---------------------------- <br /> -j-----(Date) FINAL INSPECTION B ------------ <br /> PERMIT NwZ_47-�� ISSUE ---------// Date---------------- -----•------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> Es-9-2m 9.50 W-1639 <br />