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A77 <br /> 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 AN CATI 230_ _�- �' <br /> Owner's Name...... --------- --- ----- ------- ---------------------------------- - ------------------------------------------ Phone------------------------------------ <br /> Address---_.2,,3-_0'---------/j-15-,- - - ----------------------------------------------------------------------------------------------------------�---r- --------------------------- <br /> Contractor's Name 1_C'����111�11 - -L? --------------------------------------------------------------- Phone_=1--7*/, 7--__.__ <br /> Installation will serve: Residence D� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` <br /> Number of living units: Number of bedrooms l Number of baths V Lot size---Sr �____k___to.0 f 'V <br /> W <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 ❑ Adobe ' 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_________________Distance from foundation-------------------.Material-----------------------.--------.----_-______-___ <br /> ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth--------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------.Lining material-------------------------------------- <br /> ElSize: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________________________________________-- <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> rA <br /> Se pa e Pit: Distance to nearest well' r __Distance from fo ndation__,a _*.___.Distance to-nearest lot line--- <br />_ Number of pits-------I-----------Lining material.le%1__e .Size: Diameter-----�7 '_`_____.Depth_r'x_' <br /> Disposal Field: Distance from nearest well-----------------.Distance from foundation--------------------Distance to nearest lot line--------------_ <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Width of tranch----.------•--•------------•----.-- <br /> Type of filter material-------------------------Depth of filter material----------------------- <br /> Remodeling and/or repairing (describe):----------------------------------------------------------------------------- ----------- ----------------------------•-------------- <br /> f <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 ules and regulations of the San Joaquin Local Health District. <br /> c <br /> �? or Contractor <br /> (Signed) <br /> ---- ----------------------------(-------]----- / I <br /> By:. -----------------------------------------------------------------(Tif le) <br /> 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---- _ G '.3` ------------------------------ <br /> REVIEWED BY ----------- = ------------------------ DATE----- --- <br /> BUILDINGPERMIT ISSUED----------- ------------------------------------------------------------------------------------ DATE--------------------------------------------------------- <br /> Alterations and/or recommendations:-------------------------------------------- -------------------------------------------- ------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------.,,------------------------•------------ <br /> ------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------•----------------------------------------------- <br /> PERMIT No....2-_ 7 ISSUED ------------------- (Date) FINAL INSPECTION BY:.-----W----i .-- ------------------------------- <br /> Date---------------------0-7r_,W " ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> E$-9-2M 9-50 W-1539 <br />