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APPLICATION FOR SANITATION PERMIT <br /> (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 /> '? -5, <br /> _&...Pi�j....14 ..... <br /> JOB ADDRESS AND ----&CAk-,/A- .. <br /> Owner's Name_.&S_�--------lc_=------- --- --- ---------• --------- Phone- <br /> Address----Rr !__3�--------L?_O-j?!t------2--7/-------------AAAAir_ G }-------------------------------- ------------------_- -------------. ------ ------ ---------- <br /> Contractor's Name--------- - <br /> --------------------_----------- - - - - -- ------------____------------------ Phone------------------------------ <br /> --------- <br /> Installation will serve- Residence Apartment House E] Commercial [:] Trailer Court El Motel El Other El <br /> umer of bedrooms �L Number of baths Zf/. Lot size- __,_A,3_9 <br /> Number of living units- 7 NbF--A� ----------------------_--- <br /> Water Supply: Public system [] Community system F-1 Private El <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam Do Clay Loam E] Clay F1 Adobe F1 Hardpan 0 <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.-----1b'--Distance from foundation--------//-/...Materi <br /> KNo. of compartments--------------1-_....Capacity......6,00_19ktSize-------J_14r__,e ---------- <br /> Cesspool: Distance from nearest well___-__-_.._-.__Distance from foundation___________________ Lining maierial-- <br /> F-1 Size: Diameter-------------- ....... ...............Depfh--------------------- ........ ------------ <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-.---.-..-.---.-.--.-----.---.---.._.-._. <br /> ❑ <br /> uilding----------------------------------------- <br /> 1­1 Distance to nearest lot line------------------------------------------------ <br /> Seepage <br /> ine--------- ---_--------------___----------- <br /> Seepage Pit; Distance to nearest well----------------------Distance from foundation--.-----------------Distance to nearest lot line______..__.__._._ <br /> ❑ Number <br /> ine---------- <br /> Number of pits----------------------Lining material-----------------------Size: Diameter_.--__------------_ Depth------- --------------------- <br /> -)isposal Field: Distance from nearest well---- ----Distance from foundation-------/I........Distance to nearest lot lint-_._ ---- <br /> cg� Number of lines.-----------A----------------Length of each fine----------- ___..--._--.Width of trench------------ ------- <br /> Type of filter maferiaI_&'R_&V"__Depth of filter material....._ <br /> ri <br /> Remodeling and/or repairing (describe):----- ------------- ------------------ -- ------------------------------------------------- ------------- ....... ........ <br /> ---------------------------------------------------------------------------------------------------------- ------------ ------------------- ---------------- -------- ---------------------------------------------------- <br /> ti <br /> ----------- ---------------------------------------I--------------­I--------------------------- ----------------------------------------------------------------------------------I-------------__--------------------- <br /> ---------------------------------------------- ­---------------------------------- ------ ---------------- ---------- -----­-1-------------­­­­-------- ......---------------------------------- --------- <br /> h. <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---- ----------- ------------------------------------- . .....(Owner and��Conftactorj <br /> --------------­--------- -------- -------- - - --- - <br /> BY=------------------------------------------------ ---------------- .. ........-----(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 /> APPLICATION ACCEPTED BY-- ----- -- ..-------- DATE------- .............. <br /> REVIEWED BY------------------- --------- ........ .....__------------ ------- DATE--- ...... .. --------- -- <br /> ------------------------ <br /> BUILDING <br /> - --- --------------- <br /> BUILDING PERMIT ISSUED--- ------------- --- --.­C,�', <br /> ­1_1------------ ----------------------------------........ DATE.-----j5. 1 ------......----------------- <br /> Alterations <br /> -_._----------------- <br /> Alferations and/or recommendations:----------- --- -------------------------------------------------------------- --------- <br /> -------------------------------------------------------------_--------------- -------------------------­­............... ...... ---------------­.- _---------- --- ----- --- ------ ...... <br /> ----------------------------­­------ ------------­-I------------------ ------- --------­­­­-------------------------------------------------------------------------------- <br /> - ----------------------------------------- -- --- -- ----­.­­------- ------ --------------------- ------ - ------ -- ------------- --------- - - ------ ------- <br /> ------------------ --- -------- --------­__------------- ------ --- -- ---------------------- --------- ----------------------------------------- 7------------------- <br /> PERMIT ISSUED....._.-- .-_.- .... .. ..............(Date) FINAL INSPECTION BY-,-----, ---------------- ....... <br /> ------------------------ <br /> SAN .JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />