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A PLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> s � <br /> I Health District'for a perm to construct and install the work herein described. <br /> Application is hereby made to the San Joaduin Loca <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__�� y o- R !------ --------------------------------------------------------- ------- <br /> Owner's Name----•--------------------------- � o +oPrC-------- -----------. <br /> --------- ----------- -------------- <br /> --- <br /> _ Phone--------------------------------- <br /> /qd> � � � ----------:---------------------------- ------------------------ <br /> Address-----------------•------------- <br /> r - erF <br /> ------------- Phone---------------------------------- <br /> -Name----------------------------------- ------- -------------------------------------------------------------------------- <br /> Contractor's <br /> Installation will serve: Residence dApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> E <br /> Number of living units: 'jA Number of bedrooms [71L Number of baths Ej Lot size__________-.�=_X-- - ---- <br /> Water SupOly: Public system ❑ Community system ❑ Private [� } <br /> Character of soil to a depth of 3 feet: Sand F1Gravel ❑ . Sandy Loam El Clay Loam ❑ Clay ❑ Adobe[�Hardpan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: f <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f (� <br /> Septic Tank: Distance from nearest well--$ _______Distance from foundation___------------___.Material__.GO��IT�'rK,----________-_-- v4 _ <br /> No. of compartments______ --------------Ca act f0 - - Size____3 _ -------Liquid Liquid depth--------ti______________. . <br /> Cesspool- Distance from nearest well-----------------Distance from found ation--------------------Lining material__-________-____________ <br /> ❑ Size: Diameter--------------------------------------Depth-------------------------'---------------------=--- <br /> ____Distance from nearest building � <br /> Privy: Distance from nearest well------------------------------------------------- --------'----------------------- <br /> ------- <br /> E ❑ Distance to nearest lot line---------------------------.--`,-------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- to nearest lot line________-_--_____ <br /> ❑ Number of pits----------------------Linin material-----------------------Size. Diameter-----------------------.Depth---------------- r, <br /> _ � <br /> 4�w <br /> Dispos Field: Distance from nearest,well __-___._:Distance f.rom�foundation____________________Distance'to nearest lot line_____________-.- <br /> ., <br /> -- — <br /> - Number of lines=--------___[-- ---------------Length of each line____-._l0P-----------Width of trent --�_-- -------------------------- <br /> 1 Type of filter material___-�� �� pth of filter <br /> i • / mf�a�te:rdi�al_________________�__'_�__ <br /> Re odeling and/or pairing ( cribe).....--F---x---�-----F[-----------------------_ � ' ----- ------------------ <br /> -�---h-'---------�----�-C--f-�---t--/-�--t-�---�-----G-�i--•l----------r-�-/-J--�---°-'•- <br /> f <br /> ----------------------------- --------------------------------------------------------------------------------------------------------------------------------- <br /> _ � - -------------------------------------------------------- <br /> --- <br /> --•-------------------------------------- ---- <br /> -- ------------ --- ------------------------------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la s, and rules and regulations of the San Joaquin Local Health District. <br /> - - - ---------------------------------------- --------------------------------(Owner and/or Contractor <br /> [Signed-------------------- -------'-�_z`_'_-�-- �---� <br /> Title --------------------- <br /> By:------------- -.---- ------------------------------------------------------- ------------------------------------ <br /> [Plot <br /> --------------------------—----- t <br /> buildin s, etc., must be filed with this application). <br /> [Plot plans, showingsae of lot, location of system in relation to wells, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - �"�------- ---------------------------------------- DATE------ <br /> REVIEWED BY---------------------------- -------------- -- ! = -------------------------------------------------------------- <br /> DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-------------------- - - --------- DATE----------------------.-------------------------------------- <br /> -------------------------------------- - <br /> Alterations and/or recommendations:--___________________ ----- ------ <br /> - ------------------------- <br /> --------- <br /> -- - ------------------------------ <br /> /3 "tel " <br /> PERMIT No.- f -_ ". ---------(Date) FINAL INSPECTION BY: " <br /> ISSUED f----------- .a <br /> a,. <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 />