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Coe <br /> r \1 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 /> JOB ADDRESS AND LOCATION /A.2-1.. �T l ------------­------------­ <br /> Owner's <br /> -Ta e.-k'�`--- 4.. <br /> Owner's Name----------- RA_y-• ............4._,_... :7'A--W------------------ ------------- --------------------- ----- Phone- <br /> Address SIi9 A---3--E( A 8T <br /> Contractor's Name-------------- ! Q R P-A ------------------- Phone: - ------ ---------------- <br /> Installation will serve: Residence [g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Others F] <br /> Number of living units: m Number of bedrooms [ Number of baths m Lot size......6A o_fl(------1 -' � <br /> Water Supply: Public system ,® Community system ❑ Private ❑ <br /> Xv, <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe a 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---------_----------Material---_------_-___•__--___-_____----._-_________ . <br /> ❑ No. of compartments--------------------------Capacity-----------_---------Size--------------------------------Liquid depth.................... <br /> Distance from nearest well-------------- from foundation____________________Lining material-----------_------------- <br /> Size: <br /> -•_ _- --____ --_Size: Diameter--------------------------------------Depth----------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------- <br /> Distance <br /> __--__ _-_______ -_-__ -_Distance to nearest lot line___-•-•.-__r___-•-_-------------------------- <br /> Seepage <br /> ________________ ___Seepage Pit: Distance to nearest well o_®.......Distance from,foundation-----Z.S7 Distance to nearest lot line .2.0 <br /> ® Number of pits-.------___-t---------Lining material._BR1-C.1!(....Size: Diameter____. .___.......Depth...... ---_- <br /> .Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest <br /> ❑ Number of lines_.-----------------------------_---Length of each line.......:_.....................Width of trench.................. <br /> Type of filter material.........................Depth of filter material____---_.________._-_. <br /> Remodeling and/or repairing (describe):-------------------- --•-_-------- as------ ------------ -- - ---- <br /> ---------------------------------------------------------------------------------------------------------------- ---------------------------------------------- ------------------------------------------------------ <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, an ules,and regulations of the.San Joaquin Local Health District. <br /> (Signed)-------- -- (rand/or Contractor) <br /> Br------------------------- -------- - --------------------------------------- (rtle) - - . ...... <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................. <br /> _, -4"--- ----------------•------------------- DATE----- ...... <br /> REVIEWED BY-----------•----------------=------------ f- ---------------- { , - <br /> ----------------------------------------------------------------------------- <br /> DATE-.....------------------•-�.-------.......... <br /> --------_ <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------ ---- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations---------------------------- ------------------------------------------•-----------------------•-------------------------•----------------•----------------- <br /> ------------------•-----------------------------------------------------------------------•-------------------------------------------------------------------•----------------------•-................................... <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 7-------------- <br /> ­-------------------------------------------------------------------------------•-----------------------------------------------------------------------------------------------------------•-----------=--------- <br /> PERMIT No..47:......._.. ISSUED-------- .......(Date) FINAL INSPECTION BY:......A---_ ?` <br /> Date--------------L?:._---f--`-�,.--L) <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 00 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 , { <br />