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APPLICATION FOR SANITA11ON 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. Q� <br /> JOB ADDRESS AND LOCATION --� -- --------------�. -'t- "'' ------------- ------------------- <br /> �J�J-� <br /> OwnersName------- '--------Y ----------------------------^--------------------------------------- Phone-- -------------- --- ----------- <br /> Address------------------ ----------I--- 1--- ------------------------ ---------------------- ------------------------------------------------------------------------------------------- <br /> Contractor's Name------ w -� ------------------------- - ------------------------------------------------------------------- Phone---------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commerciale ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: E4 Number of bedrooms [;�. Number of baths ❑ Lot size____`T x!___ __ _•_ <br /> Water Supply: Public system Ek-_`&ommunity system ❑ Private ❑ _ t <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: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /,-,o �'�� <br /> Septic nk: Distance from"nearest well________________Distance from foundation-----__------------.Mater,iel_______________________-__--_--f y________ <br /> No. of compartments---------r-----------Capacity-----------------------Size- x__ --k_`---G_-Liquid depth-------`�_ --------. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> El <br /> _________________________--- _____❑ Size: 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 /> Disposal Field: Distance from nearest well_________________Distance from foundation----- --------------Distance to nearest lot line___________ <br /> Number of lines_____________ Length of each line----- of french---------'-7`-------------_---_ <br /> Type of filter material_____k�` ;___Depth of filter material_-/.�______________ <br /> h ' <br /> Remodelingand/or repairing (describe)--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------l---------------- ---------------------------------------------------------------------------------- <br /> •--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------- <br /> =----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------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 an reg ations of the San aai;quin al Health District. <br /> [Signed} �� ---- - - -- ------------------------------------------------------------(Owner and/or Contractor) 5 <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 /> f------R------' DATE ------------------- <br /> -----------------------------•---------- <br /> REVIEWEDBY-------------------------------------------------- -- ------- ------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------- ------ DATE--------------- ------------------------------ <br /> Alterationsand/or recommendations-------------------------------------------------- ------------------------------------------------•-----------------....-------------------------------------- <br /> ------------------------------------------------ <br /> K--------------------------------------------------ig� <br /> &AKi7 -- Q ------- --- - - ?� --- <br /> 71 — <br /> -------•-- x _ a ----- /Jo2 �-7 <br /> - r ¢ FWe_� -�------------ <br /> PERMIT No.__35_a�-__------ ISSUED------3/Z_SIV--------------(Date) FINAL INSPECTION BY:-- 1� t1 ------------------------ <br /> Date.----------------------- -'� '/------------------- <br /> 4wk,)� q4012 PrWe Pa� <br /> SAN ,IOAQUIN LOCAL HEALTH DISTRICT <br /> ✓ +� � fi <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />