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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 /> JOB ADDRESS AND LOCATION------.-3325__Ea.st---Ensenada----------------------•------•---•--------------------------------------------------------------------- <br /> Owner's Name----------Alexauder---H].bslGo------------------------------------------------------------------- <br /> ----------------------- Phone---3-=-9-872---------------- <br /> Address---•-----------------3325--F4-.---;ns anad e. <br /> Contractors Name ._Dela_.�SE3 ZC Tam-_ 'V_.0 ------------------------------------------------------------- Phone---3!n3955--------------- <br /> Installation <br /> 1_`3955--•----•------- <br /> Installa+ion will serve:- Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 0. Number of bedrooms 1 Number of baths [1 Lot size___50'_x___9_0!__________-_______________________ <br /> Water Supply: Public system Ej Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 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______J__-------Distance from foundation------,?Df____--material----Cement--br-`Ck <br /> ® No. of compartments---------2--- -------Capacity-------0 --------- 5_'_;�4- Liquid depth--41 ------------l <br /> $04 Size____ _ _ <br /> ----------- <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___----___---_-_________________________- ` V <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ <br /> „ ® <br /> Number of pits--------I-----------Lining material.._brftCk ��+�.-_----.Depth_# _�rI <br /> Size: Diameter------ Depth--'7 <br /> Field: Distance from nearest well------------------Distance from foundation_____-_-_-___--_._Distance to nearest lot line <br /> __r____-.--._._. <br /> © Number of lines_______________3-_____________-___Length of.each line----.---50.---------------Width of trench-----App--_2______-______ <br /> Type of filter material----_--------------------Depth of filter material______--------------- <br /> Remodeling.and/or <br /> ___-_________Remodeling.and/or repairing (describe):---------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------- <br /> ------------------------------------------ <br /> ---------------Al!_---------------------------------------------------------------------------------------------- <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 /> (Signed).....Delt ep l Ski, '_y_ Ce Owner-14 '. {Owner and/or Contractor) <br /> BY: -------------------------------------------------------------------(Title) Qy7Y}eT' _T '-•------------------------ <br /> (Plot plans, showing a lot, ocati n o sys+em in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- ----------------------- ------------------------------------- DATE---------- <br /> REVIEWED BY----------------------- <br /> ---------------- f` '---�-�------------------------------------------------------------------- DATE------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------- <br /> Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------­­----------- <br /> ------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------•----------------------------------------------------------------------- ------------------------------------ <br /> PERMIT No. �`1 �� ISSUED a a'` �-------•--(Date) FINAL INSPECTION BY----------------- --- --- -- ---/ -------•-- <br /> I <br /> Date <br /> ----- ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br />�. <br /> ES-9-2M 9-50 W-1639 <br />