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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 he work herein described. <br /> This application is made incompliance with County Ordinance N S49. t-7 <br /> �,�] 09 <br /> F4 r <br /> �; --------------- -i•" <br /> JOB ADDRESS AND LOCATI N- ----- � Q 45 -- ----- <br /> j <br /> --- � 10_ . <br /> - Phone------------------------------------ <br /> Owner's Name-----------/r)-y�M_Ih�i_�_i� -------------/ � ��C� <br /> Address----------------------• / ------------- N <br /> ------------ <br /> Contractor's Name___.----�t===� ------- - - --- <br /> ---------------------��_�_�-----�� ---- <br /> I <br /> -- Phone_--------------------•------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ ^Cz <br /> -- ------------------------------------ .0 <br /> �rhl <br /> Number of living units: ' Number of bedrooms EQ Number of baths [ Lot size______________- 'r-- <br /> Water Supply: Public system ❑ Community system ❑ Private �t <br /> Character of soil to a depth of 3 feet: Sand F-1GravelT-1SandyLoam El Clay Loam F] Clay <br /> ❑ Adobe Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> (No septic tank or cesspool permitted if public <br /> sewer is available within 200 feet.) <br /> Septic/Tank: Distance from nearest well--- ------ <br /> fro foundation___.___�D- ___.Mat rial__---____ <br /> ... <br /> No. of compartments -----Capacify----40,PP------Size------ ----x.:. Liquid depth `f- ; <br /> ------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__--_______.______.Lining material_____-__________--______ 1%. <br /> ❑ ------ <br /> Size: Diameter------------------------------------Depth---------------------------------------------------- <br /> Privy: <br /> ----------------- -- --------------------- <br /> Privy: Distance from nearest well____________________________________ <br /> -------------------------------------------------Distance from' nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> D' ( <br /> f <br /> See Pit: Distance to nearest well_____L______________Distance from foundation-_-_ __--___-.Distar�Fe to nearest lot ine_-.-_,__ _ <br /> I-__-------Linin material_ : Size: Diameter--------- -----------.Depth_het-4!�Fr=---.�- ------ <br /> Number of pits--------- <br /> g ����-------- <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 trent ----------------------- - <br /> Type;,of filter material-------------------------Depth of filter material__--_-___________ <br /> Remodeling and/or repairing (describe):-------------------------------------------------------------- ------------ „f <br /> - - ------------- <br /> y��'-�iii -f------------ <br /> "_ <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 d r an re lations of the San Joaquin Local Health District. <br /> (Owner and/or Contractor) <br /> T�+leBY' ----------------( � )------------------------------------------------------------ <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, efc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_____________ ___ _______ _------------7-- <br /> DATE---------- --------- --------------- <br /> DATE - <br /> REVIEWEDBY------------------------------------------- <br /> DATE------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- <br /> ------ ------ <br /> Alterations and/or recommendations-------------------- ------------- ----------- -------------------------- <br /> -------------- <br /> --------- - <br /> ------------------------------------ <br /> -------------------- <br /> - <br /> -------•-------------------------- --------------------------------------------------------------------------------------�-------------- <br /> ---------- <br /> �j a/-5~ ----------- <br /> PERMIT No•---_��F�-'- - ISSUED_-_�------•-------------------------{Dated FINAL INSPECTION BY:-------•------------------------- ---------------- <br /> r <br /> Date----------- - --��--�--�-'-------••------ ----------.------.------------ <br /> SAN <br /> - ---------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> '1 130 South American Street <br /> Stockton, California <br /> t ES-9-2M 9-50 W-1639 "i <br />