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F ' <br /> APPLICATION FGR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> i AppliZ&fion,is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> '•+ This applicafion•is made in compliance with County Ordinance No. 549. <br /> L1J • Y� /�� S io 4:. <br /> JOB ADDRESS AND LOCATION-------- <br /> Owners Name------------------------� / _�� � -�v---�A---�`��'-- ---- - ---------------------------------- <br /> ,..-„--- Phone----------------=------- ---------- <br /> Address ----------------------------------------- -----�`-�--------------------- ------------------------- ' <br /> Contractor's Name-------------------------------------C-1-L6��7/: J <br /> ------------------------------------------------------------ Phone <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Courf ❑ Motel ❑ Other ❑ <br /> Number of living units: It Number of bedrooms & Number of baths ❑ Lot size------- ________..______•____________•_-•-_________----� <br /> Water Supply: Public system .❑ Community system ❑ Private <br /> • Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam t� 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 ank: Distance from nearest well_____________-__Distance fro, foundation____-_---_________.Material..._-___-_-•- <br /> r No. of com artments_________ __ Ca acit ��______ __Size.-_ .x_.r _________-Li Liquid depth_____ _____________� <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 /> El Distance to nearest lot line________________________________________________ <br /> to <br /> Seepage Pit: Distance <br /> errest well----------------------Dae from foundation <br /> Distance to nearest lot line <br /> ----Number PitsLining material - Size: Diameter__• Depth <br /> - - - <br /> Disposalline <br /> * I1 <br /> ' <br /> Field: Distance from nearest well from foundation____ _________Distance to nearest lot line---_______ _.__. <br /> Number of lines_______________ __ __ Length of each line:_______ o -------- of french------ ________________ <br /> Type of filter material__ _,________Depth of filter material_____IC----__-_ <br /> IRemodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------- <br /> 4 -----------------------------------------------------`-----------------•-----------------------•----------------------------------------- <br /> 4 ------------------------ <br /> ------------------------------ ------------------------------------------------------------------------------------________________________ <br /> _______________________-________-_____________-__,._____________________________-___________--____-____-_____-_-__----_____-_-___________-____________________________.___________--_________.-.____....________________ <br /> 1 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 rul s and regulations of the San Joaquin Local Health District. <br /> (Signed)----__-9?� ------------�.-"�__•• -----------------------------------------(Owner and/or Contractor) <br /> B • (Title)_ <br /> (Plot plans, showing size of lot, locaflon 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 -_-----I------------------------------ -------------------------------------------------- DATE - --- ------ ---------- <br /> BUILDING PERMIT ISSUED-----------------------•--------------------------------------------------------------- -------- DATE----- --------- ------- <br /> ------------------------ <br /> Alterations and/or recommendations----------------------------------------------------------------------------------•--•------ - -------------------------------------------------- <br /> -------------------------------------------------------------------•--------------•-------••---------------------------------------....-.-------------------------------------------•-------------------- <br /> -------•------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> PERMIT No._ ISSUED--- -5__- -- -_--_-- ( } � ��-- <br /> ---------------- - --------- Date FINAL INSPECTION BY:---------------- ---------------- ------------------------------- <br /> Date--------------------------- `�--I----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 430 South American Street <br /> ' Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />