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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 F with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--------lst---house---ofi--le#'t----a-Jde---OX----r_o_ad---sin--Qr-- -St- ---Tdorth---ofd--off' <br /> ` ast Main at El -Corral <br /> r 4 <br /> Owner's Name_ I3 ------------------------------- �� f'�hone �-�� <br /> Address-----------577 --- r-----CHOwo------------------------------------------------------------------------------ <br /> Contractor's Name---------.U�1t21...;;.�p-�.�.-C---�'�,I1�__a�_�X'Y�.�e-------------------------------------------------------- --- Phone--- 9 ------------- <br /> Installation will serve: Residence [3 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: M Number of bedrooms 21 Number of baths [I Lot size_______ 4100_ <br /> Wafer Supply: Public system ® Community system ❑ Private [] <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E� Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is availa 'thin 200 feel.) <br /> Septic Tank: Distance from nearest well__"______________Distance m fo n tion_____._________.--.Material___.______"_________________________--------__-_- <br /> ] No. of compartments------a---------------Capacity- --§00-- ----Size------•-------------------------Liquid depth------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance fr ndafion____---____________-Lining material____--------___________________--_--. <br /> ❑ Size: Diameter---------------------------------------Depth------------------------- ----Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line________________________________________-______ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- to nearest lot line----------------- <br /> KI Nusr�ber of pits.__I___1------------Lining material____b '199---Size: Diameter....3__�'1nChDepth_ C"ft_• Max--. <br /> Disposal Field: Distance from nearest well-----------------.Distance from foundation---------------------Distance to'nearest lot lin ----------------- <br /> Number of lines__------g------------------------Length of each Iine50Gf_t,__.-------------Width of french___ pP----------------------- <br /> Type of filter material----no-ek---------Depth of filter <br /> tmaterial__________________ <br /> -------------------- <br /> Remodeling and/or repairing (describe):-- New----inste.1110,U----------------- <br /> ------- --------- <br /> - <br /> ------------- <br /> ---------­------------------ <br /> rv <br /> --- <br /> ---------------- ---_-� <br /> ---------------------------------- ----------- -------- � <br /> l <br /> ----------------------•----- <br /> -------------- <br /> I hereby certify that I have prepared this application and that +he 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)--•------------•--�e-]--ta--- 1ti_ ___ ' 1 'V CG-----------------------------------------------------------------------(Owner and/or Contractor) { <br /> Owner-;!-_r'----------------------------- <br /> SY:-------------_-------------------------- -----------"(Title} -- - <br /> (plot plans, showing size of lot, location of system in relation to wells, buildings, etc., mus+ be filed with this application]. <br /> FOR DEPARTMENT USE ONLY <br /> jj APPLICATION ACCEPTED BY DATE �/'`� <br /> k <br /> REVIEWED BY ---------- ----- ----------------- DATE <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------- -------------------------------- DATE-----------------------------------------------= -------- <br /> Alterations and/or recommendations_--------------------------------------_` <br /> e <br /> / -�-------- � <br /> -------- <br />} i <br /> -- ------------------- - ------ <br /> ------ <br /> •----------- ---------------------------------- <br /> f�a Asa ."° � <br /> ----------------------------------------------------------------------•--------------•------------------------------------------_ <br /> __________ ISSUED________a- -------.---- Date FINAL INSPECTION BY:---- "____- __ <br /> PERMIT No--- 1 ---------------------- ----------------------- <br /> �L{( Date---------------- <br /> F � 3 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stock+on, California <br /> ES--9-2M 9-50 W-1639 <br />