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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. <br /> This application is made in compliance with County Ordi nce No. 549. <br /> JOB ADDRESS AND C TION _ , ;---- _ <br /> Owner's Name---- ----------- Phone------------------------------------ <br /> go�' -----�� = <br /> g <br /> Contractor's Name Ll < L� *-- "°. ---------------------------------------------------- Phone 4?f4-0----------- <br /> Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court E] Motel El Other E] <br /> Ie A <br /> Number of living units: Number of bedrooms;2„,Number of baths t Lot size---- __________________-_- <br /> Water Supply: Public system Community system ❑ Private ❑ <br /> ��s <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam E] Clay E] Adobe, Hardpan [:] t"V <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 /> F1 <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 /> ❑ Distance to nearest lot line------------------------------------------------ / <br /> Seepage Pit: Distance to nearest well--- -------Distance from fo ndation__---/D_.--.Distance to nearest lot line__-�______ <br /> J� Number of pits--------/-----------Lining material---4F - <br /> -_ -Size: Diameter-.--_Xx-- <br /> Disposal Field: Distance from nearest well-_2!--�___-Distance from foundation-___,� _..___.Distance to nearest lot line-----7-------- <br /> -------------- <br /> Number <br /> _-__--_ <br /> A� Number of lines_____________1__._--fr_-- Length of each line-----3 _ ------------Width of trench____- _-- --_--. <br /> ---- <br /> Type of filter material___ ----------------Depth of filter material------#oO I?_* <br /> Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------------------------------------------------------------- j <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 /> -- ----_1 x__- �"""���'----------------- L�+e�er►d <br /> (Signed)----"- /or Contractor) <br /> BY: eowing�sjhze <br /> ' (Title) ---------------------- <br /> (Plot plans, sof 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--------------------------------------C:D ------------=----------------------------------------- DATE----------- �- Go <br /> -7------------- <br /> REVIEWED BY------------------------------------------------ � ----- '- <br /> -- ------ -------- -- --- ---- ----•- - - ---- --------------------------- DATE-------------------------------------• -----•--------------- <br />', BUILDING PERMIT ISSUED-------------------------------------------------------------- --------------------------------------- DATE---•--------------------------------------------------------- <br />{ Alterations and/or recommendations-------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-1------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- <br /> --------------------------------------- <br /> t <br /> PERMIT No `���� '--------- ISSUED-------- --------(Dale) FINAL INSPECTION BY:-------- <br /> ------------------- ' <br /> Date-------------------t -------/-irx---v-�?----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />