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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> 1 <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------------ -- -- --------- --------- ------- V6-f-------------------------- <br /> --TOwner's Name.......... -• ------- --------------------------------------------- Phone__:!51.,/ ___?;7-------- <br /> Address---------------------.... ....�--Q------ -- -'-------ja,5, j---= --------------------------•------------------------------------------------•--•--------- <br /> Contractor's Name - l <br /> c /• f Q:l �. lri--- Phone-_�_7_.'-._ �. <br /> Installation will serve: Residence K Apartment House ❑ Commorcial-U Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -[Z] Number of bedrooms [A Number of baths Lot s z8_. x._ ........................ <br /> Water Supply: Public system ❑ Community system x Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,E]- Clay Loam ❑ Clay ❑ Adobe W Hardpan ❑1i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: {_ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well C. . ....Distance from found4ion-_-��-___-__.Material !ywx...........................� <br /> 1 No. of compartments. Q_._.___CapacityeQQ.i"r-411.Size _ :f __ :_Q,Liquid depth-n� _°..._......__� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-___-____-__-___-___----_-_____.__- <br /> ❑ Size: Diameter------------------------------ ------Depth---------------------------------------------------- <br /> 'Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________--__-__________-___-____-___.-.--. <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: Diameter-----------------_......Depth........................... <br /> .___._ � <br /> Disposal Field: Distance from nearest well-,;:50- ____.Distance from foundation...l- P...._.Distance to nearest lot line.-/a------- <br /> X�l Number of lines....0-V1F�--------------Length of each line_,1P!S___- Width of trench--- .��............. <br /> Type of filter material__R_0_ . .Depth of filter material._.!_ _____________ <br /> Remodeling and/or repairing (describe)- ._ ------------------____ <br /> .......................... ---- - ---------- ---------�� -�'--------------��.... r�........ . <br /> --------------------------......---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I hSprd this application and that the workwill be done in accord nee with San Joaquin County <br /> ordinances, S et ws, r" gulations of t e an Joaquin Local Health District.Si ned ----r-----------`( •9 ) (Owner and/ ontra r) <br /> fl�s, <br /> By � - --------.(Title)-- ------ ---- ---------- <br /> (Plot plans, showing size of tof system in relation to wuildings, etc., must be filed ith this application). t 1 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED-BY......_.------ � ----------------------------- DATE--------�...`m-.---Z-77— � �-------- <br /> REVIEWED BY---------------------------------------------------------------- <br /> ?------------------------------------------------------------ DATE-------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE..................................................---------- <br /> Alterations and/or recommendations:---------_---------------___----------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------- ---------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------•-----------------•------•--------------•-----------------------•-----------------------------_.. <br /> PERMIT No._---11_-------- ISSUED----- ----(Date) FINAL INSPECTION BY---------------------------------------------------------------- <br /> Da te----------------------------•--------------------------------------------.------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />