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s� <br /> 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 Ordnance No. 549. <br /> . <br /> JOB ADDRESS LOCATION__�`J_-a--- ----------- - -- ----------- <br /> -- <br /> Owners Name ./4 L-- �o - Phone <br /> L� - - <br /> Address- rte f ----------------------------------------------------------------------------- --------------CIO �U <br /> Name----------------------- ---- Phone----------------------------------- <br /> Contractor's <br /> Installation will serve: Residence.�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -[I Number of bedrooms 5- Number of baths , Lot size--------- Q_-`x---�`� <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 ❑ Adobe Hardpan ; <br /> �1 <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 /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> 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-------------------.Distance to nearest lot line----------------- <br /> El Number of pits—-------------------Lining material-----------------------Size: Diameter------------------------Depth--------.------------------------ <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 trench--------------------------------------- <br /> Type <br /> ----- --------------------------- -Type of filter material-------------------------Depth of filter material------------------------ <br /> Remodeling <br /> ________-__-:-__ ___Remodeling and/or repairing (describe: ------ ------ <br /> --------------------------------------------- <br /> -1 <br /> ------------------------------------------ <br /> ,7--- ---- <br /> ° f--.--------- <br /> ---------- --------- <br /> -------- <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 d rules&anoations of the San Joaquin Local Health District. <br /> (Signed) - ----------------------------------------------------:--- ----------------------------- ---------------(Owner and/or Contractor) <br /> Sy:--------------- ------------------------------------------------------------------------------------------ ------------------------(Title)------ --------------------------------------------------------- <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-------------------------- G-� { ------ DATE--------- ?� <br /> ---�-------- f { <br /> REVIEWEDBY._-•----------------------------------------------------------- - --------------------------------------------•-- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------- ------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations-----------------------------------------------------------------------------•------------------------------------•--------------------••--•------------------ <br /> PERMIT No----- -•- --- ISSUED__.-----�------------------------------- <br /> -----------------------------------•--------------------------------------------------------------------� --------------------------------- <br /> -------------------------------------------- ------------ <br /> 5- Date FINAL INSPECTION BY----------- --------------------------------------------------- <br /> Date------------------ ------------ . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />