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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 LOCATIONV <br /> --------r;___ Y-- .f----------------- <br /> Phone_ �' ��------ <br /> Owner's Name------------- Y V --- ----- r1f 6!__�Q t � : <br /> -' �-• _ <br /> ----------------------- ----------------- �P_.. - --�!-----1. 11 � <br /> _--------------------------------------- <br /> Address _ <br /> Contractor's Name-- -- -e_._A------------ ------- ------------- <br /> Installation <br /> -----------Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: [� Number of bedrooms X Number of baths Z Lot size_%V �_� --� _--_____________________ <br /> Water Supply: Public system ❑ Community system ❑ Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA, 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 /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> 0 Size: Diameter--------------------------------------Depth------------ --------------------------------------- <br /> .Privy: <br /> ------------------------------------- <br /> .Privy: Distance from nearest well-------------------------------------------------Distance from nearest buiiding__---------------------------------------V- 4, <br /> ❑ Distance to nearest lot line________________________________________________ <br /> 1 �► ...... <br /> i <br /> Seepage; Pit: Distance to nearest well__-A� <br /> ________Distance rom foundation__�0________.Distance to nearest lot line________________ <br /> ✓ �. <br /> Number of pits---11__V_��__------Lining matenal-. r_C'1_r�___Size: Diameter...s.�=�_"________.Depth. __ __________________ <br /> r . �� J <br /> Disposal Field: Distance from nearest well_�Q________.Distance from foundation__f�___-__-_--Distance to nearest lot li�--___________ <br /> [� Number of lines___11 ______-----------Length of each line_____----_ ----�_ ------Width of trench___,�,_____________------- y <br /> T' Type of filter materia/,l�__k_ ._-Depth of filter material-----/ ---------- <br /> Remodeling and/or repairing (describe):----- --- ------ -------------------------------- J------ <br /> -- .----'------- <br /> A- <br /> -----------•-•----•---------- ---------------'---------- - /_ -" ----- <br /> ----- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> i hereby certify that I have prepare this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, 5t to laws, an rules and a lations of the San Joaqui Local Health District. <br /> nn t _ �/ <br /> d ------ T -r-----e�i <br /> = -- VP_ Owner a d/ r Contractor) <br /> (Signe )---- ------ -4--- / f <br /> 11y:-----------:/!� � C _ s,_ Title ----------- <br /> (Plot plans, showing size of lot, location of system in relao wells, buildings, etc., must be filed ffh this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------------------------------------------------------------ DATE- <br /> REVIEV+/ED BY DATE---- <br /> -- ----- ----------------------------------------------------------------------------- - <br /> --- -- -------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------ __4 -`- --------------------------------------- <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------ <br /> ----------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------­__­_1--------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------- ------------------------------------------------------------------- --------------------------------------------------------------------------------- --------------------- <br /> ---_ ISSUED-- --------.1-- ------ Date FINAL INSPECTION BY-.,4----------------- {`y------------------- <br /> PERMIT No.X-11 � (Date) <br /> , � y sir <br /> Date--------------- ----------------------------------------------------- <br /> r, <br /> ___ AN JOAQUIN LOCAL HEALTH DISTRICT <br /> ""�+••. � . ,130 South American Street <br /> _ Stockton, California <br />