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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Heaffh District for a permit to construct and inst <br /> This application is made in compliance with County Ordinance NO. 549. all the work herein described. <br /> JOB ADDRESS AND LOCATION <br /> A/ <br /> Owner's Name .,.....-.-- <br /> - ----- - ---------- �---------- <br /> --- <br /> ------------- <br /> ---------.-.-.-.-.-.- <br /> C ----------------------a---------Address,- - a---- - --- - Phone <br /> - AZ-rI-- ---*--- <br /> onName--------- I -------------------------- <br /> ----- --------. - ---- ---Installation will serve: Residence ------------------------------ --- <br /> --- -- P------- <br /> pmenouse ECommercial - 1( <br /> Court T <br /> Motel E2 Other Ej <br /> Number of living units: El Number of bedrooms [N Number Of baths [0 Lot <br /> Wafer Supply: Public system E] Community system 21 Private f-I ------------------ <br /> Character of soil to a depth of 3 feet: Sand I <br /> Gravel 0 Sandy Loam E] Clay Loam,fl Clay El Adobe 0 ' Hardpan <br /> 'TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted ifpublic sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_X_? ''---Distance from foundation___// / - I <br /> 91 No. of compartments_____ Maferia�--- /?e e/ <br /> 0!' <br /> 2- --------------------------------------------- <br /> Cesspool: -------------Capacity---�FA!P�--------Size_��R__.......X'_ -C_' <br /> Distance from nearest well________________•Distance from foundation_________---__-_. 7.-_ - _..Liquid depf h------4�t__p--------------- <br /> Size: Diameter------------------------ <br /> Depth----------------------------- ----Lining material__________-_- <br /> - ------------------------ <br /> Privy: Distance from nearest well <br /> n Distance to nearest [of Distance from nearest building----------------------------------------- <br /> Seepage it: Distance to nearest well <br /> 0 --------Distance from foundation--------------------Distance to nearest lot line <br /> Disposal Field: Nuer' of Pits----------------------Lining material-______- Size: Diameter---------------------- <br /> Distance--fro;' <br /> ��arestyell------501�""Dis'f�-nc-e-'-'fro���6u�-daf-i;on�-Y.--- <br /> -_}1Vumber of lino:s---------;Z------- J;------------- EFis—fance to nearest lot I <br /> line___x-40---_` -__746"Widfh of trench__4_ <br /> -Type of filter maforial-------------------------Depth of filter material--- I.VV'* <br /> Length of each I <br /> _r- -------------- <br /> Remodeling and/or repairing (describe]----------------- -----------------I-----­--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------I----------------------------------------------------------------------------------------------11----------------------1-4------------------------------------------------------------------------ <br /> -------------I----------------------------------------------------------•--------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will------------------------------------------------------------------------------------ <br /> be done in accordance with San Joaquin County <br /> ordinances, State-laws, and rules and' regulations of the San Joaquin Local Health District. <br /> V <br /> {Signed)----------- ----------- <br /> By-----------`�-------------- -----------------------------------------------------------------------------(Owner and/or Contractor) <br /> (Plot plans. show <br /> -- --------------------4i------ (Title)---- <br /> In --------------------------------------------- <br /> g size of,10f, location of system in relation to wells, buildings,-etc., must be filed with this applicationj. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY____A__01:r_1 <br /> -- - ----------- - ---- ----- --------- DATE <br /> BUILDING PERMIT ISSU <br /> REVIEWED BY---------------------------------A - ----- --- ------ -------------- DATE----- <br /> ED---------- <br /> Alterations and/or recommendations___________________ ------ ---- ---- DATE----------------------- <br /> -------------I------------ 14-IftKt---------t-ftm*--- ----- ---------�@---------------------------------------*------I------------------- <br /> * ,----- ,_X,-1,Vr.qy je ------------------ <br /> - -------------------- ---------- --- .....57V-f (----------------------- <br /> --------------- <br /> ----------- <br /> -----------I------------------------ ------- <br /> ----------------- <br /> -----1--------A------------------------------------------------------�--------------------------------------------------------------- ------------------------------ <br /> ----------------6---A---------------------T ---- - ------------------------------ <br /> ----I------------- <br /> --- <br /> - <br /> _ ----- <br /> ----- ---------------------- --------------PERMIT No.--A ------------ ISSUED------ " (Date) FINAL INSPECTION BY: <br /> Date <br /> _!!�---------- --------- ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ES-9-2M 9-50 W4639 Stockton. California <br />