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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 LOCATION-------------13.33___E , --Stadium Drive t <br /> Owner's Name-------------------- r_ _r__- ' E: IIiaJ011GS <br /> Phone 2.!!! 2 • <br /> Address---- <br /> ------------------------1333---E_R---Stadium--�3rive--------- _____________ <br /> ------------------------------------------------ <br /> Installation will serve: 'Residence a pH SONS_ INC, <br /> Contractor's Name______ _�.--_,� <br /> ❑ ----- --- --- - --•-�-- -------- --- ----- <br /> '-- ----- Phone-----�0 _-9-`0--- <br /> --- <br /> K] Apartment House Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living u nits: Number of bedrooms [31 Number of baths Z] Lot size----- S�X$ -�_ N <br /> Water Supply: Publics stem Communit 'system <br /> - . � Y ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand p Gravel p Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ ttw-,, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: "ill <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________________-__.MaterialEl ___________-___--___ <br /> ----------------------------- <br /> No. of compartments--------------------------Capacity.......................Size--------------------------------Liqu;d depth-------------------------- <br /> Cesspool: Distance from nearest well <br /> -------------Distance from foundation_______--_________lining material-____-___.__________ <br /> ❑ Size: Diameter Depth------------------- <br /> Privy: Distance from1nearest well__________________________- <br /> -------------------------------------------------Distance from nearest building <br /> Distance to nearest lot line__________________________________ <br /> g ---------------------------- <br /> Seepage <br /> -------------------------ti i <br /> -------------- <br /> Seepage Pit: Distance to nearest well------17011(3----Distance from foundation_-71--_____-__.Distance to nearest )of line___5 <br /> xx Number of pits---------].----------Lining material__Cjr-CO�l�ze: Diameter_______- st t <br /> � 3.3--------.Depth-----20 <br /> --------------- <br /> Disposal Field- Distance from nearest well----NQI18_Distance from�toundation-----8Distance to nearest lot line--� ________- <br /> t <br /> Number of lines-----------I---------------------Length of each line---------- _20.1 <br /> Type of filter maferiaL_-1-1"' -------Width of trench__.__-______---------------------- <br /> 2--_-_- -__Depth of frlter material_____l$rt <br /> Remodeling and/or repairing (describe)______________`__Hranage_ off existing cesspool <br /> ---------------------------------------------------- <br /> ------------------------------------------------------------ <br /> ------------------------------------- -------------------- -------------------------------------------------------------------------------------------------------------------------------------- <br /> hereby certify that I have prepared this appli ation and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and gulations the San Joaquin Local Health District. <br /> (Signed) •_-A- ------------ <br /> ------ INC ' <br /> --------- ---------------------------' <br /> ------------------------------------- <br /> BY:------- ----------- - - POWEREWContrac <br /> * --- -------- --------------------------- tor) <br /> --- -----------(T'itlel------EST ZMAT OR--------- ' <br /> (Plot plans, owi size of lot, location of system in r ation to wells, buildings, etc., must be filed with this application). <br /> 3 <br /> F DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY--------------------- r_.� <br /> DATE_ -- - <br /> REVIEWED BY ----------- --------------------- ------- -- /-- -- -�-�— . .ra <br /> --- - - -__1 <br /> - ---- ------------ <br /> ------------------ -------------- ------ -------------------- DATE------ ------- ------ <br /> BUILDING PERMIT ISSUED ___________ <br /> ------ ------------------------ <br /> ----------------------------------------.-------- ----------- DATE <br /> Alterations and/or recommendations__________________________ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> - ---------------------------•--------------------- <br /> PERMIT Nd­_1-----2-y- ISSUED_-_____-_sL_�_��� --__ (Date) FINAL INSPECTION 8Y:__-_ e �------.----- <br /> Date-------------- -----!_�-�? •------�- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT r <br /> 130 South American Street <br /> ES-9-2M 9-50 W4639 Stockton, California <br />