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. 3 <br /> APPLICATION FOR SANITATION PERMIT <br /> -2,,_` (Complete in Duplicate). <br /> A plication is hereby mIde i10 le S�n�Joaquin focal Heatth Distric for� permit to construct and install the work herein 4crib$d. <br /> n Ordinance N 549. <br /> This applicatian_is,,.m*e`iri compllance,with.,Cou�yy � ----`-- <br /> s. #, ----'---- <br /> JOB ADDRESS AND' f ATION------- --------- ---- ----t--; - "— - <br /> Owner's Namer * ------ <br /> ---; f <br /> 1 Pho�ie "" - - <br /> ----- - -- ------ ----- - - <br /> Address- 14------ -- ------ _ <br /> j <br /> - -------� <br /> -------------- <br /> N � - <br /> Ccintracto�I s ame r: t <br /> Insialli ion will serve: Residence r! Apartment House ElCommercial ❑ Trailer Court❑ Mo ``Otther ❑ i <br /> '?`-_--------------- <br /> - <br /> Number of living units: Number of bedrooms Number of baths, Lot size____ i <br /> W0ter,Supply: Public system ❑ Community system ❑ Privat:�VyLoamo <br /> of 3 feet: Sand ❑ Gravel ❑ SanClay Loam ❑ Clay ❑ Adobe Hardpan <br /> ClaraaFer of soil to a depth <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> Nu septic tank or cesspool permitted if public sewer is available within 200{ret.) 0 <br /> Setic Tank' Distance from nearest well-----------------Distance from foundation___________________.Material______•.:._________________ <br /> ❑,., ,' --------Capac•ty------•--------- ---Size--------------------------------Liquid depth---- <br /> No. of compartments------------------ <br /> Cedspool' Distance from nearest well_________________Distance from`fd6ndation__.________________.Lining materia___________-___ <br /> - --- <br /> Size: Diameter --------Depth------ r -- ---------------------------- <br /> ._- _-----------__.____Distance from nearest building____________________________ __-- <br /> Privy; Distance from nearest well_____________________ <br /> ❑� / Distance to nearest lot line------------------------------------------------- <br /> f <br /> ____________________ ----_ ----------- <br /> � �� . 7!___.Di ance to nearest I� line__ -- <br /> Seeps Pit: Distance to nearesf-well__f, ------ <br /> ._Distance fpm+foy�idation [9 r/-"-._-Depth_ <br /> Number of pits_.L� Linin nctaterial_____________ Size Diameter_.- <br /> g <br /> Disposail Field: Distance from nearest well----------------..Distance from foundation--------------------Distance to nearest lot line __, 11_„ Ix, <br /> �,l Number of lines______________ ...._-- Length of each line_______.____•_______ Width of trench_________ -....... <br /> .❑ --w , <br /> 1 Type of filter material----------_---------- <br /> ____Depth of filter material________._____--- <br /> l --••--. -• = -• ............... <br /> Remodeling and or repairing (describe):-____-- -`- x7?' fi <br /> � � <br /> -------- <br /> - ---•------------------------------------------------------------------------------------------------ <br /> fy prepared <br /> pp o Health District. -------------------­------- r o <br /> ---- - <br /> I herebycern that I have re ared this application and that the work will be done in accordance with San Joa uin aunty <br /> ordinances, Stat s, an;Lrules an r ulations of th an Joan L <br /> (Signed) �. ••-- . ------ <br /> _ �--�- t Owner nd Co ' actor) <br /> ---- —� / <br /> Title---- j <br /> w � <br /> y� -4----------- - (Title) <br /> i <br /> (Plot plans, showing size of lot, location of system in relation wells, buildings, etc., must be filed ' h this application. i <br /> 4 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_____ __-_ --------------------------- �..�,�, <br /> -•----• DATE•---�-----------------------••----•----, ..... <br /> REVIEWED BY -------------------------------------------- <br /> DATE---------- -Z- ------- ---- - <br /> BUILDING PERMIT ISSUED------------------------ ------------------------•--_-----------------------------_- MATE _ 4 - !.. 4 <br /> ------------ <br /> Alterat)ons and/or recommendations________________________----------------------------------------------------------------------------------------------------- <br /> ------------------------- <br /> ----------------------j••------�-- <br /> -_--.1.__-_.L________________________________________________________ <br /> _______________________________________________________________________ <br /> __________________________ ______ <br /> ___________________________________________________________________________________C___ <br /> ............................................... _----___-.- <br /> 3 / .__ - <br /> ----- ---------- <br /> PERMIT No.-I�_._3............ ISSUED--------- ........ <br /> --- ------------------(Date) FINAL INSPECTION <br /> BccY��:. <br /> Date-------•1-•--------� ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-4M 9-50 W=1639 <br />