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APPLICATION FOR SANITATION PERMIT <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. <br /> JOBADDRESS AND LOCATION----------------------- ----------------------------------- ----------------------------------- <br /> Owner's Name Phone - 281 <br /> ------- ------------------K . 'bY lrnold -- <br /> Address----------------------------------------------------------------- 3.2-23__B.---Myr_t1- -$ ----------------------------------------------------------------------------------------- <br /> Contractor's Name A. '=l- <br /> r Sh__ C Sons,------�Y1C--------------------'------------------- — Phone- g...9Q? <br /> Installation will serve: Residence [$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: [l Number of bedrooms 21 Number of baths [I Lot size----------5G_=_--- _______________________ 4 ,� <br /> Water Supply: Public system KI Community system ❑ Private ❑ <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___Ucme__Distance from foundation-a Q!_"�________.Material.____Ci___C%__Br Ck------------------ <br /> +. <br /> No. of compartments-------i?________.___. Capacity------840___Ga�.ize__56 _ 6rr-X63r �_Liqu"d depth------, 2It-------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material-------------------------------------- <br /> ElSize: Diameter--------------------------------------Depth---------------------------------------------------- " <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest bu0cling------------------------------------------- <br /> T-1 Distance to nearest lot line_____________________________-_____-__________ <br /> Seepage Pit: Distance to nearest well__.XQ,ne--------Distance from foundation_-_,30t_______-Distanc to nearest lot line_t811 <br /> Iti Number of pits-----�_-------------Lining material_C__C__BT (3ke: Diameter---------33.........Depth----'______2�.________________ <br /> t <br /> Disposal Field: Distance from nearest well_NQne____.Distance from foundation----_0_1_________Distance to nearest lot lane__ <br /> x'$ Number of lines-------------3---------------------Length of each line________39___rr________ _2� <br /> ___Width of trench______ ___ '__._ _ <br /> Type of filter material------l�t1---�-Depth of filter material_______ ____ ________ <br /> Remodeling and/or repairing (describe):________-_-N --- ns�alation--on--sma7a--lot: <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------=--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared t is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, to laws, and r nd' regi atio an Joaquin Local Health District. <br /> [Signed} aSNC-�---------------'--------------------' {�r Contractor} <br />: '�— lTktle}Esmator <br /> { <br /> (Plot lans, showi of lot, ocation of system in rel ion to wells, buildings, etc., must be filed with this application). <br /> f � � rr''FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------�{- -----1 /- -------------------- DATE ?_­!� -f <br /> REVIEWED BY----------------------------------•----------------------------------- -------------- <br /> -------------------------------------- DATE---------------------------------------- f------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------r--------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------•-------------•---------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------•------------- -------------------------------------------•-•----------------------------------------------------------:--------------------------------------------------------------------------------------------- <br /> --------------------------------------------- ------------------- ------------------------------------•-------------------------------------------------------------- <br /> --------------------------•-------- ------ <br /> 7 `_ � <br /> PERMIT No._7_f__�---- ISSUED----____-- --r /'�- --------(Date) FINAL INSPECTION BY:----�`----------------------------------------------------- <br /> Date------------`7--�-1- =--f - --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M Mo W=1639 <br />