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t <br /> APPLICATION FOR SANITATION .PERMIT f <br /> (Complete in Duplicate) <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. Clr ; 1 'k e r " a✓r".`� <br /> JOB ADDRESS AND. LOCATION---------_T1Zt­...2r-..Bax...4Ei7r---A-'uanpQ-s---C_al1.f'*--------------------------------------- --------- ----------- <br /> Owner's Name--------Auaaell--Fr-o-m 1 t...._--2 BQx 487 AcP.�po Calif . na <br /> r--- a-------- ------------- -a--------------- - -f - -------------------- Phone------------------------------------- <br /> Address--------------------------lZt— <br /> -- -------------Address-------------------•------lZt-- 2-9----Bo-x---46-7s--Aca?pQ_,___Qa1if • -- ----------------------------------- ,. <br /> -Contractor's Name----------------Ue1.un------------------------------------ -------------------------------------------------------- Phone 3-"3955----- ------ <br /> Installation will serve: Residence © Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ "Other ❑ <br /> Number of living units: ❑].Number of bedrooms [2Number of baths ®r Lot size------ -OX2-�5_-____________________________________ <br /> Water Supply: Public system ❑ Community system ❑ Private <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ HardIn <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--_______.___-__Distance-from-foundation___-A'-_7::- Materia4____--_____�--___.-_______________ <br /> EXISTMiG No. of compartments--------------------------Capacity----------------- ---Size--------------------------------Liquid depth--------Cesspool: Distance from nearest well-----------------Distance from foundation------------_____-_.Lining material------------------------------------- <br /> El Size: Diameter---- F------------------------------Depth---------------------------------------------- <br /> Privy: Distance from nearest well---------------------------------------------------Distance from nearest building-------------------------------- <br /> ❑ Distance to nearest lot line----------------------_----------_--------------- <br /> Seepage Pit: Distance to nearest welf-----7_5------------Distance from foundation-----_-_---------- Distance to nearest lot line _--_----.t_____ <br /> ® Number of pits-----3 --_ Lining material _br1QX_____Size Diam __eter___________ -------Depth------2�?._-------------------- <br /> _Dispo,al, lield:.: .,Dislance.,from--recrest well_----- ___.DistanceTfrom=foundatio�_ nce to nearest,Jot.line_5' -__ <br /> EXISTMiG Number of lines------1-----------------•---------Length of each line-___---__533 ---------Width of trench-----2---------------------------- <br /> Type <br /> ------------ - --------- <br /> Type of filter material---r)_ck--------Depth of filter material ,_-_- -------------- <br /> Remodeling <br /> ---- _---_--Remodeling and/or repairing (describe):--------Tn&1}�- lllng---new----vert ica.l--drain---and---hookino,--�,1??--_ta---------- <br /> ---only---- ciist=c&---to__meareat---we_if-il_,_75--------- <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 laws, and rules and' regulations of the San Joaquin Local Health District. ? <br /> (Signed) y. __-- ____-- -_-_(Owner and/or Contractor) <br /> I <br /> BY ----------------Per 'Sr-Wax'that----------....-----------------------------------------------(Title)----------Qwner—T4pr'------------------- - <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this'application) � <br /> 4 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEDBY ----------------------------- <br /> --------------------------------- DATE <br /> REVIEWEDBY ------- ----- ------ --- --------------- ---------- ----------------- DATE---� --------------------------------------------_.Z, -� <br /> BUILDING PERMIT ISSUED----- - -- --------------- -------------- --- -----------------------------=------ DATE------------ ----------------------------------------- <br /> Alterations and/or recommendations----------------------- ------------------------------------------------------------- ----------------------------r�----------------- ----- <br /> --------------- <br /> ---------------------------•---------- ---------------,----------------------------------------- <br /> r <br /> ----- <br /> ----------------------------------------------•--------------------------- <br /> PERMI � ------- ISSUED-------- ---- (Date) FINAL INSPECTION BY:------:------------------------------------------------------- <br /> ----------------------------------•------------------------------ <br /> ---- -• --- -- <br /> T No. <br /> Date-------------------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br /> 1 <br />