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APPLICATION FOR SANITATION PERMIT 91'6 <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-_ ---------6 r -A� - -------------------------------------------------------------------------------------------------------- <br /> Owner's Name------------------------------------ <br /> i Phone /or�_�--------- <br /> ------------------------------------------- <br /> Address----------- ----------------------------------ZA---6-- - ` ' <br /> ��, +� ¢ Phane <br /> -- ----------- rf&1'P ----------- <br /> Contractor's Name <br /> Installation will serve: Residence §9 Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: [ZJ Number of bedrooms fi' Number baths [Z Lot size_-_�O`_ _fp_'± ----------------- <br /> Water Supply: Public system Community system F-1Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E9 Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i f <br /> Septic Tank: Distance from nearest well__ D__ _____Distance frJn foundation__I�_ _____.__.Material____ ---'u-_____ <br /> No. of compartments----------------- --Capacity----------------------- Liquid depth------_--------_ ________ <br /> lot <br /> -Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------___.--_____________._________- <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> ^Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________-------------_---------------.-. <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> 4 <br /> �/j <br /> Seepage Pit: Distance to nearest Well__10____ .......Distance from foundation________________.Distance to nearest lot line___ __________ <br /> Number of pits______/_____________Lining material�-------Size: Diameter__,�_1t"�_______-Depth_Z+47'_____�_ _______ P <br />�-- ;:Disposal Faeld:—Distance;from-nearest–well_t�_'_-.-.=..._Distance,from_founda-j_o.n:_/k_�_____-.Distance to nearest lot I��e�___�_� <br /> Number of lines______ Length of each line__ _ ' Width of french_ � _________________ <br /> Type of filter material _ Depth of filter material______- _ -_________ <br /> 'Remodeling and/or repairing (describe):___ . __� r <br /> ---------------------------------------------------------------------------------- -- - '`------ <br /> -------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------le"d <br /> -------------------------------------------------------------------------------------------------------------------------------------------------- <br /> hereby certif at I have prepis application and that the work will be done in accordance with San Joaquin County <br /> ordinancsState I ws, and r Ies andtions,,` f the San Joaquin Local Health District. <br /> 0(Signed) = r � -------------------------------------------------------------------- ------•( ' Contractor) <br /> B -------------------- - ------L ---------------------------------------------------------------------------------(Ti+[e} .[rtxc.Q .�-------------------------- <br /> (Plot plans, showing si of lot, Iota+ion f system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___ _ ______________ _ DATE - ---------------------------------------------- <br /> REVIEWED <br /> --------------------------------------------REVIEWED BY---------------------------------------- ----- --------------- ------------------- DATE------- - <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------- � N <br /> Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------- --------------- <br /> --------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- --------------------- <br /> ----------------------------------------------------------- <br /> --------------------------------------------------------- -------i <br /> ----- ----------------- --------------- ---------------------------------------------------- <br /> --- ----------------------------- <br /> PERMIT NoI v__ __d____ ISSUED------ --- ____(Date FINAL INSPECTION BY- ---------- --------------------------------------------------- <br /> Date- <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 />