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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Heaith 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 /> , <br /> JOB ADDRESS AND LOCATION----------- / `� --p- --------------------------------------------------- <br /> Owner's Name------------------------------------------- - ----------------- -------------------------- ------ Phone ' - <br /> Address----- 9-------S_e.� �? /�------------------------------------------------i- <br /> _----------------------- ----------------------------------------------------------- <br /> Contractor's Name----------------- ------------------------------------------------------ - -----#---------------------------------- Phone----2"___-Jj--0------- <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ . Motel ❑ Other ❑ <br /> _ _g,. :..m�, <br /> Number of livin units: N�imber of bedrooms �' Number of baths Lot size__________________________________________$_-____________---�` <br /> Water Supply: Public system ❑ Community system ❑ Private Al, <br /> Character of soil tof$a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej Hardpan '❑ %A& <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____ -_�)� <br /> -_ --Distance from foundation--------------------Material-------------------------------------------------- <br /> i No. of compartments-----------------r'l---CaSize---------------•----------------Liquid depth----t_t=______ -------- <br /> {- <br /> Cesspool: Distance from nearest well__'t�t]---Distance from foundation-------------------_Lining material-_--________________------------------ <br /> ❑ Size: Diameter--------------------------- ---------Depth----------------------------------------------------- <br /> 'Privy: <br /> -------------------- -----------=------------- - <br /> 'Privy: Distance from nearest well____________;__________________.___-_-_-____ --Distance from nearest building-- _______________:___----__-----___-. <br /> ❑ ,Distance to nearest lot line- ------------------------------ ------------ <br /> Seepage Pit: Distance to`nearest weli----------------------Distance from foundation___'!------------Distance to nearest lot line------.---------- t' <br /> ❑ Number of pits----------------------Lining material--------. -------____-_-Size: Diam'eter----_-----_------------.Depth--------------------------------- <br /> Disposal Field: Distance from nearest wel{__-__. Distance from foundation------to---------Distance to nearest lot line-----4: <br /> Number of lines------------ -------------------- <br /> Length of each line----------�-e---________.Width of french-------------A_4__"------------ <br /> Type of filter mate ria Depth'Depth'of filter material-------- <br /> -Remodeling and/orrepairing describe :--------1- -v�-AA'J,7-E---------Ald-a------�N,r_ ri_ _ ._ _- ------4-........ <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------------------------------`------------------- <br /> _____ ­___j____________i -_ --- -. "--i ------------- <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 regulation of the San-.Joaquin Local Health District. <br /> Owner and/or Contractor <br /> (Signed) ---- t ) <br /> /,. - - <br /> •--------------------- ----=--------- -- --------- - ---------- - <br /> (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----- \k) . .......... ------------- ---------------------------------------- DATE----- L." a G s r- ----------------------- <br /> REVIEWEDBY------------------------------------- --- ------------------------------• DATE-------y'--y-----`r-- ---- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---- ----------------------------------------------------- <br /> Alterations and/or recommendations------------- - --------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ ------- <br /> ------------------------------------------------------- ---------------------------------------------------------------t� ---------------------------------------------------------------- <br /> ---------­­----------- ------------------------- ------------------- -------- ------------ ----------- ------------------------------------ ---------------------------------------------------------------------- <br /> t---_v-- ---_-- ISSUED---- -- -- ---- �-- Date FINAL INSPECTION BY:_--- --� ,�r ------------------------ <br /> PERMIT No,l.r } <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 />