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APPLICATION FOR SANITATION PERMIT!��'-' <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> F. <br /> JOB ADDRESS AND LOCATION __ 9��__F /­'—C'�Y� <br /> _ _ _ -r -------------------------------/--y-l---/- ---T-�-�---�-. <br /> ---ti---t-D---^-�---�---- <br /> -----------------------------------/--''--Y-''----,Y/------------:-_- <br /> �-���Owner's Name------------------- ------ --------------------------------------------- - -------------------------------- <br /> �C <br /> Phone--- <br /> Address--------•--------------- <br /> Contractor's Name_------------------------- - -----✓F Phone <br /> ----------------------------------------------------------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial•❑ Trailer Court ❑ Motel ❑ Other ❑ 3 <br /> Number of living units: E6 Number of bedrooms C$. Number of baths IJ Lot size---------/_Ac-ex---f-__-_ <br /> -- ------------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private Kr <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ;# <br /> J <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well �,T7_/____Distance from foundation-----K-----------Material_-_ <br /> f------------ <br /> No. of compartments----- fir-------Capacity-----e,�P_-o.---- Size--3-xsx- ------Liquid depth----- <br /> 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 /> ___ _________________________________ ` <br /> Seepage Pit: Distance to nearest well- Distance from f undation__;�Ils------Distancr�to nearest lot <br /> Number of pits-----------/--__.____Lining material_ ___Size: Diameter- - <br /> _ -- �0-------- ---.Depth-------- <br /> .Disposal Field: Distance from nearest well `S_- -------Distance from foundation--------------------Distance to nearest lot line--- ____------ <br /> LE Number of lines-_--______.�'__ ____Length of each line------------------------------Width of trench-----a�- -_- _-_--__--_---_-- EE <br /> Type of filter material------- i -._.Depth of filter material_-_--�8'--l._______ e <br /> Remodeling and/o epairing (describe):---------- 4_f <.___---_ -�!� S_ ��a i <br /> ----------------------------------------•------- ------------------ <br /> -------------- --•-------- -------------- I <br /> ----------------- / .r ! ,�/� t <br /> t. <br /> ---------------------- - -------- <br /> ----------------- <br /> f <br /> --- ------- - <br /> hereb certify th I have prepared this application and that t work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and 011afions of the San Joaquin Local Health District. <br /> al,­,_(Signed)---------- <br /> ---- ---- ...C� <br /> ----------------------(Owner and/or Contractor) <br /> By:-- -----------------------------------------------------------------------------------------------------(Title)---------------------------------------•------------------------ Y <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must-be filed with this application). . <br /> FOR DEPARTMENT USE ONLY ,. <br /> APPLICATION ACCEPTED BY____------- DATE___________ Q <br /> -------- <br /> -------------------------------- <br /> REVIEWEDBY-------------------------------------------------------------------------------- ------------------------------------------- DATE----------�� ' <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------- -------------------- DATE <br /> Alterations and/or recommendations:------------------------- <br /> ---------------------------------------------------------._----------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -- --------•-------------------- <br /> ------------------------------------------------------- ------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- <br /> PERMIT No._,r)__S_-_/---------_ ISSUED-------- --?'-_`- -- ------------(Date) FINAL INSPECTION BY:-------- -_ .---V/ -------------------------- <br /> Date------------------------- <br /> }---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> E5-9-2M 9.50 W-1639 <br />