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G.. <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> ps e- C)" _-3 y <br /> a CO <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct'# a instal; e work herein described. <br /> This application is made in compliance with County Ordinance No. 549. q /t=Fx- <br /> '- �,/. 1 <br /> 3� __�------ + <br /> JOB ADDRESS AND LOCATION--------- <br /> - --a----------•�---------- ---------- -_"__-- Phone_-- --------- <br /> ��/)� ,(j ��/f�JJ <br /> Owners Name -------- V-9 <br /> 44-- <br /> II ------------------------- <br /> Address----�---f--- ------ ----- - ---------------------------------- Phone----------------------------------• I <br /> Contractor's Name------- - ----------------------- - �— <br /> Installation will serve: Residence �partment House ❑ <br /> Commercial E] Trailer Courtr [I Motel [IOther ❑ ' <br /> Number of living units: 5M Number of bedrooms a. Number of baths 0 Lot size _____ <br /> Water Supply: Public system El Community system El Private U;,/ Clay Loam El Clay ❑ Adobe ❑ Hardpan E1__.Character of soil to a depth of 3 feet: Sand F1 Gravel F1 Sandy L ❑ Yw <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a <br /> 4c� <br /> Septic T nk: Distance from nearest well___�B_-___._Distance from foundation_____ X__g anal_____________________ _______ ______ <br /> �(7------ <br /> - ---Size-----�------------------- Liquid depth=_ -----��------No. of compartments----------- ------- Capacity__________-- _ <br /> Cesspool: Distance from nearest well-----------------Distance from,foundation______-___--------.Lining material------------------------------------C, <br /> ❑ Size: Diameter. <br /> --De th------- ---- i <br /> ' Privy: Distance from nearest we4l_______________ <br /> _____"--"_�_"-:"____�"_____Distance from nearest building--""--------------- <br /> Distance to nearest lot line------------------------------------------------------------------------------------ <br /> Seepage Pit: <br /> Distance to nearest well______________________Distance from foundSZenQiameter___ Distance tODepthst lot line----------------- <br /> ' <br /> -_------- {� <br /> ❑ z Number of pits_________________ ___Lining material__ _ <br /> 7'_j-�f""-____Distance to nearest lot line___ S�"� <br /> r� <br /> g ------ ' ---- trench <br /> Disposal Field: Distance from,nearest well_ -----_.Distance from foundation-A__ <br /> " Number of lines-------------- --- -------Len th of each line <br /> `q--------Width of ------ -----�---`'J-- ------�. <br /> Type of filter ma+erial___ -� '-------Depth of filter matersal___ __l "------- <br /> Remodeling and/or repairing (describe}:_____ __,. ------------------------------- <br /> ------------------- <br /> ""--: <br /> - I- <br /> ------------------------------------------------------- <br /> -------------------------------------—----•------ ---------------------------------------------------- <br /> s ... <br /> ------------------------------------------------------ <br /> 1 hereby certify that I have prepaedula this <br /> i pplicthe San Joaquin that <br /> the <br /> work <br /> Health will <br /> beDi t done <br /> in accordance with San JoaquinCo n <br /> ordinances, State laws, and rules and g �. <br /> (Owner and/or Contractor <br /> Si ned [! -- ----- <br /> --------- <br /> --- <br /> ( 9 } :--------(Title]------------------------------------------------------ <br /> BY= i- ---- --- --------- - ------------ --- <br /> - - -------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application. <br /> FOR DEPARTMENT USE ONLY <br /> -- ------ - ------------------- - <br /> DATE------' j = -------------------APPLICATION ACCEPTED BY----------------------------------------- ------•-- DATE-------- ------------------------ <br /> - ------- ------ <br /> REVIEWED BY---------------------- ----------------- ------ <br /> ------------- <br /> 3 BUILDING PERMIT ISSUED----------------------------------------------------------------------------- - ----•- -•------ ----------------------------------------- <br /> -------------------- <br /> -----------------------L--------------------------- <br /> and/or recommendations:"_--_---_-_"""-- --------------------------------------------------- <br /> ------------------------------------------------------ <br /> ----- <br /> -------------------- ------- <br /> .. <br /> ----------------------------------------------- <br /> -- <br /> -- <br /> ---------------------------------------------- <br /> /�-A ;{-So Date -.FINAL INSPECTION BY:_----�------------- <br /> ( PERMIT No--------1-72------ ISSUED --------------- { } <br /> Date----------------- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT�r' <br /> 430 South American Street <br /> Stockton, California � ):� �_�,N►-- J <br /> E5--9-2M 9-50 W=1639 r / <br />