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37 <br /> ` APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> l <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 L� CATION____3 0_____�= - - <br /> . JD -------------------------------- ------------- <br /> Owner's Name-----------t Cv......'------ --------------------------------=------- Phone <br /> Address------------------------- <br /> -- ---------------------------------- -------------------------------------------------- ----------------------------- ---------------------------------------------- <br /> Contractor's Name__________ __<,a -_-_.- -AA'r— - <br /> -------- e-- --------=--------------------------- ----- - - - ------ Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ ~► <br /> ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: E] Number of bedrooms �] Number of baths ] Lot size------- <br /> Water Supply: Public system A 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.) - R <br /> Septic Tank: Distance from nearest well__-_SV__----Distance from foundation------Lb___-_ .Material----------- <br /> ------------------------------------- <br /> No. of compartments------------ ----------- Capacity-----W-d----------Size---` --'<-�_*X_?---------Liquid depth-----S AAll <br /> - <br /> Cesspool: Distance from nearest welL________________Distance from foundation--------------------Lining material-------------------------------------- <br /> El Size: Diameter--------------------------------------Depth------------------------- <br /> -------------------------- <br /> Privy: Distance from nearest well_________________________ --_________Distance from nearest building----- <br /> ------------------------- <br /> Distance to nearest lot line___________________________�_--_____--_-_--___ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_______________-_ <br /> [� Number of pits----------------------Lining material--- -----------------Size; Diame+er--- =-= Depfih--- <br /> -ti- <br /> - -_ ----- ---- - ---------- <br />,,�.�..Dis�posa^ l,,Field: Distance from nearest"well_::__-5510-- .Distance from foundation------1--Q_ _____Distance to nearest lot line____-577_- _____ <br /> �Numbeiof lines______________ Width of trench-_________ <br /> 1� ro� Length of each line--------- ----� <br /> Type of filter material______________ ____----Depth of <br /> Remodeling and/or repairing (describe):_______________ ______________ ___ L <br /> -------------------- <br /> ------------------------------------------------------------ <br /> _s <br /> ------------------------------------------------- <br /> __________________ <br /> ____________ <br /> _________ <br /> ________.__-________ ______________________________________________________________________________________________________________________________________________________________________________________s_-_______ t <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San'Joaqui_n County <br /> ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. <br /> Signed - ' <br /> ( 9 ) 1---1_ --- .. -" . *----------------------------------------------- ------r--(Owner and/or Contractor) <br /> � 7 <br /> ---------------------- <br /> By:-------------------------------•-------------------------------------------- -- - Title ____ <br /> - ------------------------------------------------------ <br /> (Plot plans, showing size of W, 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----------- - -- - <br /> ���_/REVIEWED BY---------------------------------------- S <br /> --------------------------------------- DATE - -- <br /> -------------------------------- <br /> - ---------------------- <br /> ULLDING PERMIT ISSUED <br /> ------------------------- <br /> ------------ DATE-- ------------------------------- <br /> - ------------------------------ - <br /> Alterations and/or recommendations___________________ __ <br /> -------------------------------------•----------------- . <br /> ------------------------I--------------- <br /> ---------------------------------------------------------------- ----------------------- <br /> PERMIT <br /> ------------ - -- -- <br /> PERMIT No.-3-4tl--------- ISSUED_-------�3'/ -_ -� (pate) FINAL INSPECTION 13Y--- ---------- <br /> Date------------------ <br /> v` <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES--9-2M 4-50 W=1"639 <br />