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x <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> �v <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 /> JOBADDRESS AND LOCATION 1812- Berkeley --------------------------------------------------------------------------------------------------------------- <br /> Charles Roberts ---------------'---------------------- <br /> Owner's Name-------------- •------------------------------------------------------------------------------- i <br /> Address_.. 1812 Berkeley - ------ <br /> --- - ------------------------------- ------------------------------------------------------------ <br /> Contractor's Name---------------•----------•-Dgl ta----------------------------------------------------- <br /> Phone 3:n3-955--------------- { <br /> Installation will serve: Residence®Apartment House F-1CommercialE] Trailer Court [-] Motel El Other E] f' <br /> Number of living units:?] Number of bedrooms [ Number of baths'❑2 Lot.size------5QXI.5.0--------------------------------------- <br /> Water Supply: Public system ESC Community system ❑ .Private ❑ <br /> Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [3 Hardpan ❑ <br /> I <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__________------- <br /> Distance from foundation__-_--------------Material_____-_-_______________--___________________-. <br /> XISTOG No. of compartments ---Ca aci -- - '- <br /> Size----------------------------- Liquid depth-------------------------- i <br /> Cesspool: Distance from nearest'well-________________Distance from foundation--------------------Lining material---------------------------------------- <br /> ❑ Size. Diameter------------------------------�-----Depth---------------=----------------------------------- <br /> rivy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- <br /> l ❑ Distance to nearest lot line------------------------------------------------ <br /> I <br /> See age Pit: ,,. Distance to nearest well--------------------Distance from foundation___5 ---------Disfance to nearest lot line___5-__1!4p <br /> - <br /> Number of pits_____._.._1_____-..Lining material______br1t%�__Size: Diameter___y._Q•�-------.Depth---------2.�----------Disposal Field: Distance from nearest-well_________________.Distance from foundation___:______________--Distance to nearest lot line------------­ <br /> Disposal <br /> Number of lines-------------------=---------------Length of each line---------`---------------"---Wid'th of trench--------------------------Type of filter material_________________________Depth of filter material.---_ ______.________ <br /> Remodeling and/or repairing (describe):'______=IAsta---ling_-r�ew-_vertical---dz!ain--only__ and hooking <br /> to the existngtank with---ao� d--link, �----------------------------------------------------------------- �---------- <br /> -r <br /> s <br /> - <br /> ----------_----------_-------------_------------------------------------------------------------------------------------------------------------------.--_c__________________..--__...---------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be d ne in accordance with San Joaquin C8unty <br /> ordinances, State laws, and rules and regulations of the San Joaqu' oca Health rsfrict. <br /> (5rgned)------------------- elia-----._.------------------------------------ - . ------------ -------(Owner Owner and or Contractor <br /> Perr Warthan/ <br /> Owner—Mgr.r. <br /> By-----------------------------------------y------- ---------- � - --- ------ - �` �'�'�-------[Title)i-le i ------------p -c do - <br /> (Plot plans, showing size of lot, location of systemI relati n to el s, buildings, etc., must be fled with this application). " <br /> t FOR'DEPARTMENT USE ONLY <br /> ' ------ DATE---9 <br /> APPLICATION ACCEPTED BY --------------------- <br /> REVIEWEDBY------------------------------- N ----------------------- DATE `--------;----- - <br /> BUILDINGPERMIT ISSUED----------------------------------------- ='---------•-------------------------------------------=- DATE------------0 ------------------------------------------- <br /> Alterations and/or recommendations------------------- '------------------------------------------------- ------ ------------------------------I---------------------------------- <br /> ------------------------------------------------- <br /> -----------------_--------------- ----------------------------- ------ -------------------------•--- <br /> F --------------------------•-------------------------- ------------------------------------------•----------- <br /> --•----------------------------------------------------- <br /> -------------------------------------------------------------------------------•--•--•--------------------------------------------------------•-- ---------•----------------------------------- <br /> ------------y - ISSUED------------- f Date FINAL INSPECTION f3Y:____ '-_ :_ . -------------- <br /> PERMIT Na----- -- - - - ---�- - ----- ( 7 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639,- <br />