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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 LOCATION-------- <br /> Owner's Name...---- 4 <br /> ----------/--- -----a-`i` <br /> -A ---------fr--------------------------_ <br /> Address----------- ----- - --- ------- Phone-It'.07 .�ce- --------- <br /> Contractor's Name-___...._._ - ___-____-_ - ------------ ---------;------------- ----- ------------------------------------------------------r--- ------------------ <br /> Installation will serve: Residence ;Q L]Apartment House Commercial EI Tra-ile t-r­_Cour--_El----M o <br /> Number of living units: JE Number of bedrooms Number of baths I/ Lot size. �Pl El Other El <br /> Water Supply: Public system Community system E];K Private r-I <br /> Character of soil to a depth of 3 feet: Sand [I Gravel [] Sandy Loam El Clay Loam E3 Clay EI Adobe 0( 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 /> 1­1 No. of compartments--...-------------------Capacity..------------.......-Size------------------_------------Liquid depth----------- <br /> Cesspool: Distance from nearest well..............._Distance from foundation------------------Lining material.._.____.__..__.__ <br /> 11 Size: Diameter---------------------------------Depth--------- -- --------- -- ---...... .. ... <br /> Privy: Distance from nearest well._._________.............__.-..___..._____.Distance from nearest building----------------- --------- <br /> F-1 Distance to nearest ]of line.___..__--------- --------------------- <br /> Seepage Pit: Distance to nearest well-----------------...Distance from foundation-----------------..Distance to nearest lot line-_...__.. ..... <br /> 171 Number of pits---------------------Lining material.--------------------Size: Diametefr----------------------Depth--------------------- - <br /> Disposal Field: Distance from nearest well__._-__ <br /> Distance from foundation---4�If--- ---.Distance to nearest lot line- ? <br /> Number of lines_.__..___../. t Length of each line__..__-- - irf__ _?------- <br /> -------- material___.._`--_--_ -------- ---- <br /> Width of french-------- <br /> Type of filter material--j-ih.6tDepfh of filter -- <br /> Remodeling and/or repairing (describe):._...___..._.- ---------- <br /> ---------------- ------------------------------------I-------------------------------V---------------------------- -------- ---------­­­--------------- ---------------------------------------- <br /> -----------------------------------------I----------------------­------ ---------------------------------------------------------------- -------------------­­---------------------------------------------- <br /> ------------------------------ ---------------------------------------------------- <br /> I <br /> -------------------------------------------­----------I hereby certify that I have pared this application and that the work will be done in accordance with San Joaquin County <br /> , St <br /> that I h. , du <br /> ordinances, S1 S. rul nd regulations of the San Joaquin Local Health District. <br /> (signed)--- ---- -- --- -- -- -------- - -------------------------------------------------------- (Owner and/or Contractor) <br /> By:-------------_-------------- ----------- -­ ------------ <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----------W--- ----- - _-----A/--------- ------ -------------------------------- DATE---.... <br /> REVIEWEDBY..--------------------------------------_----------V----------------------------------- -------------------------: DATE-------------- <br /> BUILDINGPERMIT ISSUED---------_---------------------------------------------------------------------------------------- DATE--------- ------------------------------------------ <br /> Alterationsand/or recommendations:___.______.__.-------------------------------------------------------- ----------------------------------------------------------- ----------------------------------------------I------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------- ------------------------ --------- ---------­­1----------­----------- <br /> -----------------­-----------------------------------------------------------------------------------------------------------__------------------------------------- --------------------- - <br /> ----------------------------------------------------------- -- ---- ---­---- --------------------------------- -------------------------------I------- - -------- <br /> - -------­ <br /> PERMIT No..---i;�il__C�_ISSUED----- FINAL INSPECTION BY:._...__.._ __�/--- ------------------­ <br /> Date-- 7 —--------------------­-------------­ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ES-9-2M 9-50 W-1639 Stockton, California <br />