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APPLICATION FOR SANITATION PERMIT <br /> 'D I (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. 5549. <br /> JOB ADDRESS AND LOCATION------------- ---------_----.- ! (f f iii------------------------------------------------------------------------------------ <br /> Owner's Name------------ .........Q_------- � � ' ------- ----G-"--�-------- - -n-/- '--f-J---� =--------------------------- Phone------------------- <br /> --------------- <br /> ---------_------------------------------- ._---•-------- <br /> Address --- ------------------------------------- - <br /> y <br /> Gwa*aa&�egs Name - •- R-7M 671/o-------------------1--- =-=-------+--- --- `gip ---�� Phone <br /> Installation will serve: Residence a Apartment House El Commercial ❑ Trailer Court [I •Motel ❑ Other ❑ <br /> Number of living units: �1 Number of bedrooms ❑ Number of baths L� Lot size-------- ------ -__,__-_____________ <br /> Water Supply: Public system ❑ Community system ❑ Private & <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ Adobe Hardpan-'j] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept' Tank: Distance from nearest well_____Ste'_Distance from foundation____to-./-___-Materi 1_________________._______-__________________. <br /> p _ Q � <br /> No. of compartments Capacity --------------- Size x {3: Liquid depth - <br /> Cesspool: Distance from nearest well_________________Distance from foundation__________________.Lining material_________-_---------------------------- <br /> ❑ Size: ----------------------- r <br /> Privy: Distance from nearest well______'________________________________________Distance from nearest building----------------------------------------- <br /> Distance <br /> _____________________-_'________-------Distance to nearest lot line------------------------------------------------ <br /> Seepage <br /> ______________________________________________Seepage Pit: Distance to nearest well------"--------------Distance from foundation----------------.__.Distance to nearest lot line____________----. it <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------.------._----------_.---- <br /> Disposal Field: Distance from nearest well_____`��_'_Distance from foundation------�_________.Distance to nearest lot line___ _'----_ <br /> Number of lines____________`Y:____.__G,_____�+ength of each line________��_0__--___:__.Width of trench______� �� <br /> Type of filter material_____ !�YDepth of filter material_______ --------- <br /> Remodeling and/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------'----------- <br /> ---------------------- 4--- ---'ir------r------------ - --- ---- ------- -; ------- ---- =. --- ----....... - - <br /> .... r;, ,-- r---•-------------- -- <br /> ------------------------------------- ----- <br /> ----------------------- ------------- - <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 /> (5igned)__________________ __________________ - (Owner and/or Contractor) <br /> --- -- --------------------------------------------------------------------------------------------- <br /> By:- - ----------------------------------------------------------------(Title)--------------------------------------------------------------- <br /> (Plot plans, showing Size of lot, location of s tem in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------A �~ -- -----------------:-------- DATE___________ <br /> ------- <br /> REVIEWED BY---------------------=------- ----------------------- ------- ------------- - ----------------- DATE---------- --L - --; <br /> ---------� <br /> ----------- <br /> BUILDING PERMIT <br /> -- --,-- - IS--S-_hUED^-------s--. _����._°�,�k_�#_��--••--,- <br /> -------- <br /> ' <br /> x -- ----------- - <br /> ....f.�N..�.. �� � recommendations: <br /> -k- <br /> ----- ------ r �Alterations and/or recommendations:--------- -----6- ��.[�_ ------------- <br /> ----- - ------------------- <br /> --- <br /> --------=------------------------------------ -.1--------- ----- -------- - --- . -------------------------------------------------------------------------------------------------------------------------------- -- <br /> --------------------------------------=--------------------------------------------------------------------- WTA- ----^------------------------------------- ------------- <br /> PERMIT No '7{ ISSUED4� `�✓\ IDateJ FINAL INSPECTION BY:------ " <br /> - Date----------------- rk' - --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> t °`a-SO*W-1639 <br />