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37b <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> t 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_____________2409--North---S-argent_-Ae.y__Stoek _on,___Galif._____________- <br /> --------------- <br /> aOwner's Name-------------- ------ry- I'll@St---LM10------------------------------------------------------------------------------------------- Phone----------5---51+23------- <br /> Address---------------------------------2409---N•---urgent-_Ave_;---Sto-ekton,----G_alif--------------------------------------------------------------------- <br /> I� ' ----------A---- Phone9-X647---- <br /> �w ------------- <br /> Contractor s Name-- P,__A p81^TYI__ -_s7011S-7_ _C- ------------.---- <br /> .Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Mote Other ❑ <br /> p �x 75i -1o5t <br /> Number of living u i�its: ❑1 Number of bedrooms [Z Number of baths [] Lot size----_�_�-___- <br /> Water Supply: Public system [Z Community system 1771 Private <br /> Character of soil to a depth of 3 feet: Sand E] Gravel Sandy,Loam ❑ Clay Loam El Clay ❑ Adobe [X Hardpan ❑_�c <br /> I1. V <br /> TYPE OF INSTALLATION`AND SPECIFICATIONS: <br /> (No septic fank or cesspool permitted if public se0 Awer is availab"it 20ateeg <br /> Septic Tank: Distanc� from nearest well- Qi _ =U�s dOri ,C4 foundation-------10t---.Materisal___-Circ-a__C-em_ent----Bricl <br /> No. of compartments--------2----------------Capacity--800---G----Size--50!---fi t Liquid depth----------5211--------- <br /> It <br /> Cesspool: Distanlfe from nearest well_- ----------Distance from foundation--__X6 --_---.Lining material------------------------------------- <br /> T ❑ Size: Diameter-------------------%------------------Depth--------------------- ------------- ----- <br /> Privy: Distance from nearest well--------- - --Distance from nearest building---_--_--------------------------------- <br /> ❑ D€stan�e to nearest lot <br /> I` line-----------------_------------------------------- <br /> plus <br /> ----_---__------__--_--_--- <br /> p utSeepage Pit: Distance to nearest well------r9t_____-__ stance from foundation-___-_ Q�-___.Dis#atnte to nearest <br /> rest lot line---- <br /> --- -e <br /> p ize: Diameter t--------.Depth---------- Q-Z---------- <br /> ----------- <br /> - <br /> v1 <br /> Numbuer of psis-----3------ ------Lining material--c�C `s <br /> �l <br /> _Disposal Field: Distance from nearest well-------�0_t__.Distance from foundation----10-1-------.Distance to nearest lot line---------6t--- <br /> Numb�'r of lines-------3. �t Length of each line---------5��-t�__--_-----Width of trench------------Z�t ---------------- <br /> Type of filter-material--1*------Rk----Depth of filter material-----1�_------ <br /> Remodeling and/or repaill'ling (describe)-----------------------New__instal-lation�------Nearest---�ze_ l i� 'il�� r�th <br /> ------------dirt--and_81�ndaned;------Property---s-er-ued---hy--Calif ornia------Water <br /> ------------14------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------- ! -------- <br /> -------- - - - ------------------------- ----- -- - <br /> r I hereby certify fhatil have prepared this applicat'�n and that the work will 6e done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of a San Joaquin Local Health District. <br /> (Signe R&__ ----+ - rr - - -- ---SQ s } x �.-------------•---------&-------a----------•------+-------•-------•----------(�r Contractor <br /> I' <br /> J_ IL11_4 <br /> (Title)--E S t imata '------------------------------ --- <br /> - - --------------- ------------------------- - <br /> (Plot ans, 4ow' g size of lot, location of system in afi n to wells, buildings, etc., must be filed with this application). <br /> R DEPARTMENT USE ONLY <br /> 1 DATE l <br /> APPLICATION ACCEPTED BY---------------------- <br /> II - r-,----- - �---------------------------------------------------- DATE------------ - '�f-±�l ----------------------- <br /> REVIEWED BY------------------- <br /> ------------------- -------------- ------- - --------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------- ----- DATE <br /> Alterations and/or recomlm endations----------------- ------------------ --------------------- ----------------------------------------- <br /> ------------ -I, <br /> -------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------- <br /> IM -------------- -------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------ --------------------- ------------------------------------------------ <br /> PERMIT No---!J _-�-------� ISSUED-------- �------------jDatel FINAL INSPECTION BY---------------------------- ------------------------------------ <br /> Date------------------ �� � �`� -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />