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APPLICATION FOR SANITATION PERMIT l <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 /> JOB ADDRESS AND <br /> ---------------------------------------------------•-------------------------------- <br /> Owner's Name--------4-_•__----__ aP � -- <br /> -----------�`-- <br /> -------------------------------------------------------------------- Phone___""_ -f-- <br /> ---------- <br /> Address- -------� _ - A=tl------ �"' ------------------------------- <br /> Phone------------------------------------- --------------------------- ------------------------------- -------------------- <br /> Contractor's Name-----0_s____ <br /> Installation will serve: Residence KApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: [] Number of bedrooms Number of baths Lot size__ a !_k !T_]C1-r---------------- <br /> Water Supply: Public system�'* Community system ❑ Private Ej <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam Clay Adobe <br /> ❑ Y ❑ Hardpan ❑ <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_-___g.------------Material----r_________ _ <br /> No. of compartments----------2------------Capacity----?Ar"4WSize_^1. Li id depth__e�� <br /> ---------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material________--__----____ <br /> ❑ Size: Diameter -----Depth---------------------------------------------------- <br /> Privy: Distance from nearest well_____-_____s'=__-______ '-----------------------Distance from nearest building---------------------------------------- <br /> ❑ Distance to nearest lot line--------- <br /> __-''____---- <br /> .______:______ <br /> Seepage Pit: Distance to nearest well-_________--________Distance from foundation___--__ ------Distance to nearest lot line____/a-�____ <br /> Number of-pits--------.�x____-__-_Lining materiel.-- z_-$ize: Diameter---�`-_____-____-Depth�lc-�0� - a_- <br /> Disposal Field.: Distance from nearest well------------------ from foundation------__ ----------Distance_;o nearest lot li e_________._.- <br /> Number of lines_______ ______ T_ Length of each line______f �'' _ _�__.Width of french <br /> th of filter material_________��' <br /> Type of filter ma#eriaL___ �-�'--- - p �-_ ._ <br /> Remodeling and/or repairing desc iib): ---- - - --------- <br /> ------------•------------------------- ------- _ 'f� f Zj � �" -- -- - --- -- <br /> �.. <br /> ------------------------- <br /> . I ---�- ------------------- `-- --�-- . , ------------ <br /> = = ------------------------ <br /> ordinances, State laws, an' rules end regulations of the San Joaquin Local <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> al Health District. <br /> (Signed)..-- . ' ��l-} ---- Q"; <br /> ------------ --------------------------------------- <br /> Ll. <br /> t.r.. nersand/or Contractor) <br /> 13 :------- --- ,.�`'�/�r ------ --- --- <br /> Y - - {Title)(Title)- -Z_ l .�rht-- <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__________ _ a <br /> ---------------------- -------------------- DATE----------- --- --�--f�3--------------- <br /> REVIEWED BY = � t <br /> - ------------------- ------------------------- ---------------- DATE--------------�---•------------ <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------- ----- <br /> Alterations and/or recommendations------------------- --------- _- - <br /> ------------------------------•----------=---------------=----------------- ----------------------------_-------------------- <br /> i--------------------------------------------------------------------------------------------------------------------•----- " <br /> 4 f� <br /> ----------_----------------------------------------------------_-----------------_________________ -_-----_________--____-_________-_______________-----_-_______-_-__________-_ -_____________-__.__-___.-_____-___-___.-______ <br /> .- <br /> p.. . <br /> ------------------------g--� --------------------------------------------------------------------- ---- -� <br /> �;;PERMIT No_________________________ ----------(Date) FINAL INSPECTION BY:_--- -_-wvm ­ <br /> Date <br /> ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> T 130 South American Street <br /> Stockton, California -7 <br /> ES-9-2M 9-50 W-1539 <br />