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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_..--------�A -_ -—-� --- ----------------------------•-------------------------- <br /> i ----- �--- ------------ Phone------- ------ <br /> Address <br /> -- <br /> Owner's Name-----7��`rr ------ ----- - --------- - ----------��- -- - -- <br /> Address----...._. ---------------------------------------­--------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name s- ------- ----------- Phone <br /> Installation will serve: Residence ►[Apartment House ❑ Commercial ❑ railer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: W Number of bedrooms Q Number of baths LO Lot size----------- __________________ <br /> Water Supply: Public system ❑ Community system ❑ Private .[� <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ElClay Loam ❑ Clay Adobex Hardpan E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: y ` <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r <br /> Septic ank: Distance from nearest well_��_�____Distance from foundation____- ¢_� �_.MaQterial_.-____`�* .1- ------------------ <br /> 9 -Ca Capacity —d& -----Size----X 6-X/--------Liquid depth_____��`p-------- <br /> No. of compartments-------- p ty_.___-- ---- <br /> Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material_.-__________--______-_-- ____._-.. <br /> rtt----- Size: Diameter------•-------------------------------Depth--------•------------------------------------------- f <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----_________---_______________ <br /> ___B — Distance to nearest lot line------------------------------------------------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> _11— <br /> _.___-__-_-______ 11— Number of pits----------------------Lining material--_--------------------Size: Diameter---------------..------.Depth--------------------------------- <br /> Disposal Field: Distance from nearest well_-•.,�__V�_-_.Distance from found ___________ation___ -0_'f_Distance to nearest lot line------------------ <br /> �/ Number of lines-------------A-__________-___-_Length of each line----•a���------------Width of french-------- _- <br /> Type of filter material___ „` _ yr-Depth of filter material----___A!!__-____ <br /> Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------...----------------------------------------------------- <br /> ------------------------------------------------------- <br /> --------------- <br /> --------------- --- -- ------ ------- ----------- ---—------ ----------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify <br /> -- <br /> that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S ate laws, and rules an ` regulations of the San Joaquin Local Health District. <br /> r, <br /> (Signed) ''L!t.fes!. r �-----------------------------------------------------------------------------(Owner and/or Contractor) <br /> BY:------------------------------------------------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- <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 1� S <br /> --- <br /> ------------------------------------------- <br /> REVIEWED BY ---------------- DATE l4` ter` <br /> BUILDINGPERMIT ISSUED--------------------------- -------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations--------------------------------------- ----------------------------------------•---------------------------------------------------------------------------- <br /> -----------------------------------------­----------------------•------------------------------------------------------------------­---------------------------------- ----------- <br /> ------------------------------------ ------------------------------------------------------------------------------- <br /> --------------------------------------I-------------------------•------------------------------------------•-1----------------------- _4� -------------------------------- <br /> PERMIT No.__-_� --__-- ISSUED----/,a!` ��-----------(Date) FINAL INSPECTION BY-------------- -- ---�_--_ --------49------------------- <br /> Date---------------_- ------ ----------- <br /> SAN <br /> --------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California ' <br /> ES-9-2M 9-50 W=1639 <br />