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7 <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> G> <br /> A is hereby made to the San Joaquin Local Health District for a permit to construct and install th'work herein 'I scribed. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS 1.AND LO.CATION--------Ant//j2_j;kt------ ---—------ <br /> ----------------- ----- :-------------------------------------- P <br /> Owner's Name-_'?&6�w )------0(�1 _ <br /> ------------- -----------------------------------------------------------------I----------- <br /> Address-61:2-14- -------------------------------------------------------------------------- i--- - I . <br /> I ,- -------- <br /> Con+ractor's Name------------------------------------------------------------------------------ .- M�----------: --------------- Phone--------=------------------------- <br /> Installation will serve: Residence 9---A-partment House E] Commercial El Trailer Court E] >Motel Ej Other E] IN <br /> [of <br /> Number of living units: Fj] Number of bedrooms gL Number of g .16-aths 2, size <br /> -------------------------------)------------------------------- <br /> • <br /> Wa+er,Supply: Public system [-] Community system F] Private `1 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam E] Clay Loam F] Clay 0 Adobe❑ Hardpan E]l <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---/0-01---Distance from foundation--------------------Material-------- -_____________ <br /> No. of compartments---------SR------------Cd pa city-..- Liquid depth-------5--------------- <br /> Cesspool: Distance from nearest well------ <br /> -----------Distance from foundation--------------------Lining material___________________________________. K, <br /> ' <br /> Size: Diameter--------------------------------------Depth--------------------------- <br /> Distance from nearest well-------------------------------------------------Disfaneeifrom-neafest-buildi�g--- -- <br /> ' ----- <br /> Privy: --i--------------------- <br /> ----- <br /> _B Distance to nearest lot line______________________________ ""r" W <br /> Seepage <br /> ine----------------------------------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line________________ <br /> �_ Number <br /> ine-------------- <br /> Number of pits---------------------Lining material-___-________________Size: Diameter------------------------Depth------------------------------ <br /> �Disposal Field- Distance from nearest well____1.QA!'__.Distance from found Distance to nearest lot line------------------ <br /> El Number of lines-------------—------------------Length of each line------1_;_1 1__________.Width of trench-_-_--Z_'_0.................... <br /> Type of filter material__�Otrn---------Depth of filter material---------/,p---------- <br /> Remodeling and/or repairing (describe):-------------------------------- ------------ ----------- -------- <br /> ----------------- ------------ <br /> ---------------------------------------------------------------------------------------------------- -------------------------------- ------- --------I----------------------- ------------------------------- <br /> -------------------------------------------I---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------- -- - ----------- ---------- <br /> ---------I-herebyi- `--- certify--------- - that_-------- have I------__----prepared re_---a- ed <br /> _r this application <br /> s----- __ -,-- d'-that-the-work will-w-i-1-1--be-_d o n-e--in--accordance-with-_San- - -_Joaquin--County-- <br /> ordinances, State laws, and'rules a dulatio/n o the San Joaquin Local Health District. <br /> j <br /> (Signed).X,____ .......I ... _011 <br /> ..... ........... <br /> --------------------------------------------------------------- - --------------------------------------------------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------------------------------------------------------------{Title)_ <br /> (Plot <br /> Title)-(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________________________ --------------------`"--—------------- DATE-------- <br /> ------------------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------Vhi`---------------------------------------- DATE---------1eZ-I4A-- --------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:----------------------------------------------------------------- ----------------------------------------------------------I------11-------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------­--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> PERMIT No._.e?—_/__7----------- ISSUED__- -------fDafel FINAL INSPECTION BY:--------i-ji-V------ ------------------------ <br /> Date---------------- <br /> -------------- <br /> Daie----------------- ----------------------------------- <br /> 1 SAN JOAQUIN LOCAL HEALTH-DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES--9-2M 9-50 W-1639 <br />