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APPLICATION FOR SANITATION PERMIT <br /> ^ A r (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----- Q ..4.0 '...... <br /> Owner's Name-- -41--- <br /> ---7 ---•-- <br /> ----- ' --- ----- <br /> ---•------------------------------ --- Phone----'� �--�------� - <br /> Addressl r.. (lSf ,J----------------------------------------------------------------------------- _-_- ----------------- <br /> Contractor's Name----{-„ -------------------------------------------------- Phone------------------------------------ <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:-Z Pumber of bedrooms k Number of baths ® Lot size------------�1-�.: _." ___ ------ <br /> Water Supply: Public system 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.) <br /> Septic nk: Distance from nearest well Distance frp�n foundation_______ ________Material........Cp4! �'__ !, <br /> No. of compartments--------------------------Capacity-_ .........Size___-.�X-VY-197--Liquid depth____-_._7. _______. <br /> Cesspool: Distance from nearest well_________________Distance from foundation_--_-_--_-__.___-__.Lining material-------------------------------------- <br /> Size: <br /> -__-__-________._ .-•..___---_-__-.Size: Diameter--------------------------------------Dept h--_---------------- ------------------------ <br /> Privy: Distance from nearest well------------------------------------_------------Distance from nearest building-_------------------------------------ <br /> El <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------------------------Dept h__--__--__-_•--_---------___-_--- <br /> ,Dispo I Field: Distance from nearest well___' --._.Distance from foundation-----I O(_--__-Distance to nearest to line.....,,........ <br /> Number of lines....... ___ _.______ _Length of each line -_____ -d..........Width of trench_._•...X!--------------------- <br /> Type of filter materia!____-__------ Depth of filter material--____ <br /> Remodeling and/or repairing (describe):-..-------------------------------------------------------------------------------------------------------•----•------ ....,._.:� .............. <br /> -------------------------------------------------------------•------------------------------------------------•-----------------------------------------------------------------------------------------------------------_- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--- <br /> -------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------..........................------------•' <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State)aws, and rul s and regulations of the San Joaquin Local Health District. <br /> (Signed) - ---c - - ----- _- •---_-•(Owner and/or Contractor) <br /> BY. - -----------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- <br /> (Plot plans, owing size of lot, location of system in relation to wells,,buildings, etc., must be filedwiththis application). <br /> F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------- -- ----------------------------------------------------------------- DATE.- <br /> REVIEWED BY--------------------------------------- -- -- --------- DATE-- ��- --------- <br /> BUILDINGPERMIT ISSUED------------------------------------------- --------•--------------------------------------------- DATE---------------------------------------- <br /> Alterationsand/or recommendations-----------------------------------------------------------------------------------------------------------•-------------------------------------------------- <br /> ------------------------------------ ------------------ ..............................•--••------•-------------• `--- ------ •... <br /> PERMIT No..__.__....?.K. ISSUED..__..- �__,_._�--3____"'.(Date) FINAL INSPECTION BY:..... -r%'-----r... ............................ <br /> �r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />