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A � <br />-r <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. �L <br />This application is made in compliance with County Ordinance No. 549. <br />JOBADDRESS_ AND LOCATION--- 2427---E-•___P_op1ar------------------------------------------------------------------------------------------------------------------- <br />Owner's Name -------------- 11r__•---- i1C r T" � .a.�.8-------------------------------------------------------------------- Phone -2-n-476-8 <br />Address --------------- X42$--Z--•---P53pl�'-- --=- -------------------- <br />Contractor's Name----------1)alta-------------------------------------------------------------------------- ---------------------------------------- Phone --------3"'-'3i 5---------- ' <br />Installation will serve: Residence: ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />Number of living units: .M Number of bedrooms [2 Number of baths ❑j. Lot size ----- 7jhl_rj_0---------------------------------------- <br />Water Supply: Public system ® Community system ❑ Private ❑ <br />Character of soil to a depth of 3 fee+: Sand ❑ . Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe F] Hardpan [1 w <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 />exlgting No. of compartments-----2------------------Capacity----800----------Size---9X 3 ----•---------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 />❑ Distance to nearest lot line ___________-_________________________________ <br />'Seepage Pit: Distance to nearest well ------- <br />`- -------- Distance from foundation___- -Distance to nearest lot line_-_ZG___/_-_ <br />P <br />Z] only Number of pits ------- ------------- Lining material ___b±_ick------ Size. Diameter _____fj_a_------------- .Depth ------- _---------------- <br />f 1 <br />Disposal <br />NumI <br />Field: Distance <br />from nearest well,---_- <br />-_.__f.�a <br />.Distance -from foundation____�______-Distance-to nearest lot line___ <br />C <br />__.-_-____ Length of each line____________/_n-_'----------Width of trench____ <br />Type of filter material_________________________ Depth of filter material ----------------------- <br />Remodeling and/or repairing (describe)________________r_ep ging.__-_---- aixia"lling --- new----u-ext-ical---------------------------------- <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)----------------------De_1t&-------------------------------- <br />------------------------ -- --------- -------------------------------------------(Owner and/or Contractor) <br />By: Y W_ax' hurl �'L-------------------(Title)-- Owner.: ��I -.* -------------------------------- <br />, <br />plans, showing size of lot, location of system i relation to wets, buildings, etc., must be filed with this application). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY ------ -__V__j <br />REVIEWED BY--------------------- ------------------------- -- <br />BUILDING PERMIT ISSUED ----------------------------- <br />Alterations and/or recommendations --------------- <br />V---------------------------------------------------------------- DATE ------- <br />--------------------------------------------- DATE------ ------------------ <br />-------------------- <br />-------------------------------- --------------------------------------- DATE ------------------ <br />-------------------------------- <br />--------------- <br />-------------------------------------------------------------------------------------------------------------------------------------------- <br />----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- <br />---------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ <br />------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br />-- - - - -- -- ------------------------------------------------------------------------------------------------- <br />ISSU ED V <br />PERMIT Nb - l j__________(Date) FINAL INSPECTION BY:_------__VU-------------------------------------------------- <br />Date -------------- <br />T <br />---------- <br />Date------------- <br />i SAN JOAQUIN LOCAL HEALTH DISTRICT <br />30 South American Street <br />Stockton, California <br />ES ---9-2M 9-50 W=1639 <br />