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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 /> !� ------------------------------------------------------ ---- <br /> JOB ADDRESS AND LOCA ION------------/ - ------ ,-----_- - t-- --��1-- ----------------- <br /> U � e l' ------------ --- ---------- Phone------------------------- <br /> Owner's Name---------------- --� ---- --- ------------------------ -- ------ <br /> Address---------------------- ----------5-----< 4-1-�------------------------- ---------------------------------------------------------- <br /> Contractor's Name--------------------�el ----------------------------------------------------- ----------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Pcommunity <br /> umber of bedrooms T Number of baths 0 Lot size---------- _.x_ s-_ - <br /> ----------------- V <br /> Water Supply: Public system system ❑ Private ❑ <br /> Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ -Clay Loam ❑ Clay ❑ Adobe&LAardpan ❑ <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 /> ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> ElSize: 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 foundation-------------------.Distance to nearest lot line--_-_--_....._._ <br /> ❑ Number of pits----------------------Lining material.-......--------------.Size: Diameter-----------------------.Depth-----_-------- ------- _------- <br /> ,,_Dis osa Field: Distance from nearest we 1_1011_=kDistance from foundation.._.-C.p-----._..Distance to nearest lot line-----,1 <br /> Number of lines._....._ <br /> ------ --------------- Length of each line--------��-�-------�-k.Width of trench-------•�----------------------- <br /> Type of filter material-------.Z____):of, Depth of filter material---------- -- <br /> -Remodeling and/or repairing (describe)-------------------------------------------------•-------------------------------------------------------------------------------------------------------- <br /> -•---------------•--------- - . -- -------- ---------------------- ' <br /> , � /�' <br /> �x �> 5 <br /> ----------------------------------------------------------------------•-- ---------------------------------------------------------- -- - <br /> I hereby certify that I have prepared this application and +hat 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 /> (Signed)-- - -- • _-4 -------------------------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:------------------------------ --------------------------------------------------------------------------------------------- ----(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------- --------------------------------------------------------- DATE------------ <br /> REVIEWEDBY--------------------------------------- -- --- _W-------------------------------------------- -------------- DATE----------------------------•------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:--------------------------- ---------- -----------------------------------------------------•------------------------..-..------------------------------------ <br /> --------------------------------------------------------------------------------------------- ----------------------------------------------------------•------............................................................... # <br /> F <br /> ..................................................................•_.-....__-_._-_-.----.--...._-.__._..------"----.-.._........-----.._-.-..-..._-.-`-`-----........-------------------`--------•-`-`-------------- <br /> ........................................................................................:...............................-.------.........---------.........-----"`-------....._...---.......---------..._..------------ <br /> ------. ISSUED-- `3 --Y--�------------------(Date) FINAL INSPECTION BY:-------- --V- ------------------------------------------------------------ <br /> - <br /> PERMIT No.--�.-.$ 7 <br /> Date-------- ----------3- -- --------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br />�' ES-9-2M 9-50 W-1639 <br />