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0 <br /> APPLICATION•�� ON FOR SANITATION PERMIT <br /> J(4 (Complete in Duplicate) / O 'l <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........... 1936-So......Ad@lbert.........................................................................-------- <br /> Owner's Name-----------------------------------------------------------------14R --Ti_a__Vr1ght------------------------------------------- Phone--------3_3_47k --------- <br /> --AddAddress--------------------------------------------- <br /> ress--------------------------------------------------a-036---SQ.---Adel.bet•t--------------------------------------------------------•-------------------------------------------------- <br /> Contractor's Name ; _ TT1SY1 & SOI1s! In---------------------------------------- Phone------9-9607---------- <br /> Installation will serve:.• Residence [Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel-0 Other❑ <br /> Number of living units:11 Number of bedrooms$] Number of baths m Lot size---5Q_10r1---------------------------------------- <br /> Wafer <br /> Water Supply: Public system JOE Community system ❑ Private ❑ O <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q Hardpan ❑ kU <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 /> HOMO No. of compartments-----------_-----------Capacity-----------------------Size------------_-------_--------Liquid depth-------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------_-----______Lining material___________________________-_---_____.El <br /> Size: Diameter-----------------------------=--------Depth---------------------------------------------------- <br /> 'Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------_-_____-. <br /> ❑ Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well-------ZOQ!-__Distance from foundationW-----------Distance to nearest lot line........ <br /> Number ofpits________1_____.__.._l-ining materialC_-_C__Brj4e: Diameter_____33!..........Depth-----25!------------=-- <br /> .Disposal Field: Distance from nearest well.____.__._____..Distance from foundation--------------------Distance to nearest lot line____-________-__ <br /> ❑ Number of lines___________________________________Length of each line..-_-___- _-.-__-__________.Width of french____________________-___.__________ <br /> Type of filter material_________________________Depth of filter material------- <br /> DrAAAA a ff gistm • <br /> Remodeling and/or repairing (describe) oe - ------infste <br /> - s---------------------;-i--------------------............................................ <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, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) .- �. R-.CARR-SH- SONS INC. -' ( Contractor) <br /> ----------- <br /> ..------------ ---- -------- ......-- --------- ------I---------------------(rifle)-----Estimator------------------------------- <br /> (Plot plans, showi size of lot, location of sy in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY f -- ------------------ ------------------------ ------ DATE ----------a �� /------------ <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------- ---- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:------------------------------------------------- ------------- ----------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------•------------------------------------------------------------------------------------------------•------------------------------•---------------------------- <br /> ----------------------------------------------••--•-----------------------------------------------------------------------•------------------------------------------------------- ------------------------------ <br /> PERMIT No.-CC.-?__-------- ISSUED----- .1_ f-`-/-------(Date) FINAL INSPECTION BY--------------------W-----�--------------------------------------- <br /> Date--------------C------------q------ .......--------.---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />