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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> I ' 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.wjjitt'h County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION ---- 7_Q ? vtl��.r ---------I7---- e------ -`------•------------------------ <br /> - " ! 7T-tF li/ F�W!S Phone__ _D 0_ _� ---------- <br /> Owners Name-----._.�6_R�`hF_i�F�-�'y�-------Q_r-�--'----� �-tda_G8__�_CG ------- <br /> `� -- I '-------=------•----------- <br /> Contrac#or s Name-------------5t- --- ------------------------- ---- <br /> ------ Phone----------------------------------- <br /> El <br /> installation will serve: Residence Apartment House [:1Commercial E] Trailer Court ❑ Motel E] Other <br /> Number of living units: [f] Number of bedrooms Rg-Number of baths U Lot size----- __X_l__ --0 B <br /> Water Supply: Public system 19 Community system ❑ ..Private ❑ <br /> Character of soil to a depth"of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: O <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.______________-_________________-- A. ' <br /> ❑ No. of compartments--------------------------Capacity Size--------------------------------Liquid depth-------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation____________--_____.Lining materia_________________-_____._______-_ -. <br /> ❑ Size: Diameter--------------------------------------Depth------------------------------------------;--------- <br /> 4 _Distance from nearest building ---- <br /> .Privy: Distance from nearest well----------------------------------------------- 9 <br /> ❑ Distance to nearest lot line______________________i______----____________- l <br /> Seepage Pit: Distance to nearest well._________.�_____Distance from foundation__-__V+_Q-___.Distance to nearest lot line_____ <br /> f <br /> Numbeof pits---------I-----------Lining material---V_R_r4_k---Size: Diameter__ 3_0-----------Depth--------2-0---s- <br /> ------------ <br /> - <br /> Disposal Field: Distance from nearest well-----------------.Distance from foundation--------------------Distance to nearest lot line---------.------- <br /> Number of lines-----------------------------------Len4th of each line------------------------------Width of french----------------------------------- <br /> Type of filter material-------------------------Depth;of filter material_______________-_ <br /> # Remodeling and/or repairing (describe)________________ ,- <br /> 0-------------------------------- <br /> --------------------------------------------------------------------------------------- <br /> I hereby certify that I have pre aced this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State-laws, an r les regulations of the San Joaquin Local Health District. <br /> (Signed}_ -------------- <br /> w--------------------------------------------------"--------------------(O_wner_and/or Contractor) <br /> -- <br /> _6 <br /> ------------------------------------- Title ------------ -- --on)---------f---------- <br /> ( plans, showing <br /> ---- ----------_----- - ----- ----- -------------------------- buildings, etc., must be filed with this application). <br /> Plot lans, showin size of lot, location of system in relation to wells, <br /> FOR DEPARTMENT°USE ONLY <br /> APPLICATION ACCEPTED BY---------------------- (� � <br /> -- DATE--- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------- - ---------------------- <br /> DATE <br /> Alterations and/or recommendations------------------- ------------------------ ------------------------------ <br /> -----------------------I---------------------------------------------------- <br /> ----------------------_--- ------------------------------------------------------------•--------------- ------------------------------ <br /> -------------- <br /> 't PERMIT No.__ -3 -------- ISSUED----- ------ ----------------(Date) FINAL INSPECTION BY:------- ---- ------------------------------------ <br /> ---; .e,--�- - j <br /> Date--------•------ '-------------------- <br /> [ <br /> SAN JOAQUIN LOCAL'HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />