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i <br /> k <br /> APPLICATION FOR SANITATION PERMIT * e I 7d <br /> �- (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District for aermit to construct and install th wo . <br /> This application is made in compliance with County Ordinance No. 549. p e rk herein described. <br /> I I� <br /> /O <br /> JOB ADDRESS AND LOCATION ____..- <br /> O c� iPt C105, l <br /> j - --- --------------------------------------------------------------------------------- <br /> Owner's Name-------------------•------- 0 `f 3 `:1 <br /> ---------------- ------- --------------------------------------------- ------------- Phone----------------= <br /> ----------------•- /cJ 0 n -�'fil�'�-C4- <br /> Address <br /> Contractor's Name------------- e�trJ-zt�y� Phone_-, <br /> • ---•---------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ❑ Number of bedrooms E;I-Number of baths L1' Lot <br /> size___________- -- -`--------------_ <br /> Water Supply: Publics stem '/Community ._ <br /> ` <br /> system ❑ Private ❑ � I <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan J <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-----------------Distance from foundation--------------------Material <br /> ________________ <br /> ElNo. of compartments----------- ------Capacity-----------------------Size-----------------•-------------Liquid depth--- - -� <br /> Cesspool. Distance from nearest well-----------------Distance from foundation_________---______.Lining material________---__- il_ <br /> ❑ Size: Diameter--------------------------------------Depth------------------------------------------------ <br /> Privy: Distance from nearest well_________________________ ___-----Distance from nearest building-----------------------4_ <br /> 171 <br /> Distance to nearest lot line------------ <br /> r <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- to nearest lot line----------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth----------------_---------___--- <br /> Disposal Field: Distance from nearest well---------------- Distance from foundation--------------------Distance to nearest lot lin ��___ `.-__ <br /> Number of lines________________' / g - ------------ <br /> =- th of each line Q Width of trench --------- <br /> Type of filter materi i'__ _- � th of filter material_-____fs <br /> - 1 <br /> Remodeling and/or repairing {describe):------ ------------- -------------------------------------- <br /> ------- -- �' <br /> ----------------- ------------------------------zllr� .✓G <br /> ------------------ - <br /> --------------- --------- ---- ------------ --------------------- <br /> ---------- <br /> �c i 41 --------- <br /> - ---------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared Phis application and that the work will be-done in accordance with San Joaquin County <br /> ordinances, State laws, and <br /> jrules <br /> �and regulations of the San Joaquin Local Health District. <br /> (Signed)---------- -- -------------- <br /> --- ------------- ----------------- ------------------ ----------=----------(Owner and/or Contractor) <br /> $Y=-----------------------------------------------------------------------------------------------------------------------------------(Title)----------------------------------- ---------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> S <br /> APPLICATION ACCEPTED BY------------------------- ------- -- -- <br /> ------------------------------------ DATE----------------------------------- <br /> REVIEWED BY - �----1--�------------------------------------------------ "z <br /> i'-------------- <br /> - -- -- ------------- DATE------- ----------------''-----------�---------------- <br /> BUILDING PERMIT. ISSUED--------------------------------------------------------------- E <br /> - - -------------- DATE------- --------------_.•-----•--------- <br /> . . ---------------- <br /> Alterations and/or recommendations--------------•------ - -= M <br /> ---------------------- --------------------------------- <br /> -------------------------------------------------------- <br /> 11 <br /> 'yy <br /> r.. it <br /> ---------------I------------------------I----- - 1 <br /> .-_ •----------- i <br /> PERMIT No----?_v--------•---- ISSUED---I�_�-c :_- -----(Date) FINAL INSPECTION BY:------ <br /> Date - --V--��t <br /> 4 <br /> - <br /> 3--------- ------ <br /> ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />