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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Applica}ion 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 /> f <br /> JOB ADDRESS LO ATION__._______._12-0 2f O /� � f/XTr�{ .(� , <br /> _ --- <br /> w <br /> r Owner's Name-- ------------ -- �'� _chi=/ / J� --•-----•--- ---------------- <br /> i {-t-iY y1L11 _ 1'Y� A ------ <br /> Address--------------------------•-- �oS'� 4{ Phone <br /> ------------------- <br /> on rectors Name---------------- ----------••------------- <br /> - -------------❑ <br /> ----- -------------------- Phone---------- <br /> C , <br /> Installation will serve: Residence Apartment House ommercial <br /> r ❑ Trailer Court ❑ Motel <br /> Number of living units: .❑ Number of bedrooms ❑ Other ❑ <br /> Number of baths �o} size- _-___6-0 -x /[v p <br /> 1 Water Supply: Public system B"' ------ <br /> f� Community system ❑ Private `-- <br /> r. Character of soil to a depth of 3 feet: Sand ❑ Gravel p 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.) <br /> Septic Tank: Distance from nearest well_-_rte---___Distance from foundation___�D•-__-- <br /> ---.Material ��'✓G�i�No. Of of compartments---------------- ------Capacity----- �-a---_-- -- , <br /> Cess ool: :------?------Liquid depth----�----------- r <br />,^ ❑p Distance from nearest well_________.__.___Distance from foundation____________________Lining material_____-_-__-_--_____ __ <br /> Size: Diameter---------------------- <br /> Depth ----------- ------ --- - <br /> Y- Distance from nearest well__________________------- c <br /> -----------------------Distance from nearest building ^a <br /> ❑ Distance to nearesfiIlot line------------------------------------------------ 9 ----------Seepage Pit- Distance to nearest well_______________•_- <br /> ___Distance from foundation--------------------Distance to nearest lof.fine----------------- <br /> El Number of pits-----/-------------Lining materia!----------------------- <br /> Size: Diameter_----------_-----------De }h-----------�-------•-- <br /> Dispos�l Field: Distance from nearest well__________________Distance from foundation-------------------- po— <br /> d <br /> Number of lines_.__-- •----__Dis}ante to nearest lo} line ___--_-___ <br /> Length of each line_ _ So /} I � --- <br /> Type of filter materiel__ '--' _��+De #h of filter materia�F__- - ' ,+p• yWiath of french______ <br /> Depth <br /> Remodeling and/or repairing (describe):---------------------------------------------------- <br /> -------------------------------------------------- <br /> ----------- <br /> --------------------------------------------- <br /> - <br /> ---------------- <br /> ------------------------------------------------------------------------------------------------------•--•------------------------------ - - - ------------ --------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San•- -- -- <br /> Joaquin C-oun--ty <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----- •-1 -- -_(!V... <br /> - <br /> r <br /> SY- ----------------------------------- ----- -- ----(Owner and/or Contractor) <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 /> i FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY __ ! - <br /> � ------------------------------------------------- <br /> - <br /> DATE -f-BUILDING PERMIT ISSUED______ ----- d- -1---------- ------ ------ ------ --------- DATE------------ / : -a--y�.-r----- <br /> -------• <br /> _______Alterations and/or recommenda_tions:--------------------------------------------------------------------------------------- DATE-- ----------- ------- <br /> -----------_• --------- :----------- <br /> -------------------------------- <br /> --------------------------- -----------•------------- <br /> - <br /> � ------- V--------------------------- <br /> Wf ---a----- <br /> ✓------------------ r - <br /> ------------------- ---------- --------------------- <br /> - <br /> PERMIT No --------- ISSUED-----------------------------------------(bate) FINA IN ECTION BY�­_;__ <br /> --� <br /> _ -- <br /> _,--- -----V <br /> SAN JOAQUIN LOCAL EALTH DISTRICT E <br /> 130 South American Street <br />\FS--9-2M 9-50 W=1639 Stockton, California r <br />