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dp <br /> APPLICATION FOR SANITATION PERMIT <br /> = ' " (Complete ' Duplicate) <br /> 7d_ ��� <br /> tr�for a permit to construct and install the work herein described. <br /> Application is hereby made to the San Joaquin Local Health D ) <br /> This application is made in compliance with County Ordinance No. 549. <br /> ,IOB ADDRESS A LOCATION - r , ------------------------------------------------------------------------------------------------- <br /> Mty <br /> -------- ----------------------------------- <br /> Phone----------------------------------- <br /> Owners ame___________________ <br /> ' } <br /> � __. _ __. ---. - ---------------------------- <br /> Address------•---- -------------- --------- --------- ---------- - - - <br /> - ------------------------- <br /> -------- ----------------------•----------- <br /> --- Phone---------------------------•------ .- <br /> Contractor's Name----- ----- ----------------------------------------------------- --------- - , <br /> ---------- Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Installation will serve: Residence Apartment House ❑ ❑ / � <br /> Number of living units: f B 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 F1 Gravel 171 Sandy Loam ❑ Clay Loam ❑ Clay [IAdo>,e• Ha`rdpa L] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)r « nn , <br /> ��_U.---Material___t9 - <br /> r Septic ank: Distance from nearest well___ --Dis#ante from foundation___ ____ <br /> dU ---Size X=` -----Liquid depth------- --------------- <br /> No. <br /> ---- f---- <br /> No. of compartments "- Capacity <br />'I4_ ------ V F <br /> r <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material"______________-___ <br /> ❑ Size: Diameter--------------------------------------Dept ---------------------------------------------------- <br /> Privy: <br /> --------------------- ----------------------------- <br /> �. Distance from nearest well__________________________ <br /> ----------------------Distance from nearest building----------------------------------------- <br /> Distance <br /> _-____------------- -- <br /> [ Privy❑: 4 <br /> f Distance to nearest lot line-------•- ` Distance from foundation___________________.Distance fio nearest lot line___-______-.-- <br /> 1 <br /> I Seepage Pit: Distance to nearest well______________________ <br /> �. ❑ Number of pits Lining material-----------------------Size: Diameter------------------------Depfh�---------------.._-----yf---- <br /> .2 aE-^ t <br /> Dispos ield: Distance from nearest well" _------.Distance from foundation----- - --------Distance tt nearest lo# line_-___-`-_ __ <br /> Number of lines-------------- -------------- Length of each line__3.5'--h i u-Width of trench---------- rG1 rf <br /> Type of filter material__!(-7y y-�--------Depth of filter material.______ 2_--___.___ <br /> Remodeling and/or repairing (describe):----------------------------------------------------------- <br /> ---------------------------------------•----� <br /> i -------------------------------------- <br /> ---------------------------------- <br /> -----------------------•----------------------------------- <br /> I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and' regula+ions hof the San Joaquin Local Health District. <br /> (Signed)---- - ,� --s• ---------------- ----------- -------- <br /> _______--__(Owner and/or Contractor) <br /> f/'Wl ------- -------�- <br /> (Title) <br /> By:------------------------------•----------------------------------------------------------- <br /> ---------------------------------------------------------------- <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-------- I�------- _ !q <br /> _ " <br /> REVIEWED BY----------------------------------- ------- -- -------"----------------------------------------------" <br /> DATE _ -- <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------------------- <br /> -------------- ----------- DATE------------------------------------------------------------------------------------ <br /> . '-------------------------------------------------------------- <br /> Alterations and/or recommendations:------------------- <br /> ---------------------------- --------------------------- <br /> - <br /> -------------------------------- <br /> ---------------------- <br /> --------------------•--- ----- --- --------------------------------------------------- <br /> - --------------- --------------= ----- --------- ---------------- <br /> r� / ��—`1 Date FINAL INSPECTION BY:-------��----- ------------ -"------------- --------- <br /> PERMIT No--- -------- ISSUED - 71 (Date <br /> t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-so W=1639 <br />