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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 /> JOB ADDRESS AND OCATfON_!_/_J__Q cl7 <br /> Owner's Name.______ --- -- ----- - I----------------- Zne------------------------------------------------------------ <br /> --------------------------------------------------------- Phone <br /> Address-----ZX-J-6:7- <br /> Contractor's Name-- ------------------------------------------------------------------------------------------------------------- <br /> _.A�--------- .4------ ----------------------------------------------------- Phone-J, <br /> Installation will serve: Residence lk� Apartment House Commercial E] Trailer Court [] X <br /> 14 Motel Ej Other ❑ <br /> Number of living units: Number of bedrooms Number of baths Lot size <br /> Water Supply: Public system 0 '1 2— 0 - ------------------------ <br /> *� Community system [] Private Ej- - <br /> Character of soil to a depth of 3 feet. Sand Ej Grav'el Ej Sandy Loam E] Clay Loam ❑El Clay [I Adobe Hardpan <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public <br /> sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_ -___ ''-'..Distance from foundation--------------------Material <br /> 171, No. of compartments--------------------------Capacity-----------------------Size_.__.--------- -------------- <br /> --------------Liquid depth-------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Linin'g material_� <br /> 0 Size: Diameter------------------------ <br /> ------------Depth---------------------------------------------------- k <br /> Privy: Distance from nearest well <br /> ----------------------------------Distance from nearest building------------------------------------------ <br /> Distance to nearest lot line <br /> Seepage'Pit: Distance to nearest weH---'!�_Distance m T - Y <br /> ,Wfodation__- `_ <br /> - ------------Distance to nearest lot line___- - __-_ <br /> Number of pits--------:k--------Linin'g material---4 - ----------size: Diameter----- <br /> Disposal Field: ----------------- <br /> Distance from nearest well-- -----Distance from foundation--- # 40 f <br /> /4P-------Distance to nearest lot line--- <br /> Number of lines____________ ___ <br /> Length of each line_________-( _! -Width of french-----—2 <br /> Type of filter materia!__-/ ii- J -------------------- <br /> A %t---Depth of filter nn�aferial------ 2_4 0 <br /> - --------- <br /> Remodeling and/or repairing (describ''e):---------------------- <br /> - 41 <br /> --------- <br /> ------------------------------------------------------------------------------------------------------------------ <br /> -----------------I-----------------------------I--------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------I-------------------- I ------------- -- <br /> }. <br /> ----------------------------------------------------------- ------------ <br /> ----------I—------------------------------------- <br /> ------------------- -------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> -- - -- - --- -- - - -- -- -- -- --- ---- -------------------------------------- ------------------ <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---VrAl_--- <br /> By:---- -------------------------------------(_T__ -e-)-------------------fQ*n8r-"w_id_/o_r Contractor) <br /> -------------------------------------------------------------------- 4%A4,V�-- ----------------------- <br /> (Plot plans, showing size of lot, location'of system in relation to wells, building s,'ef c., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------ <br /> REVIEWED BY �_ Z? --------------------------------I DATE----------- <br /> -------------------------------------------------------------------------------------------------------- DATE--------------- <br /> BUILDING PERMIT ISS __%Y <br /> ----------------- -- --------- ------I-------------------- <br /> DTE------ - ----------- <br /> Ald ------- ---— --- ------------ <br /> Alterations an /or recomnpendaf3'pns.,---7..- -s-t-----,-5-- J Z_ ------_,�2 4- <br /> Z&A--- <br /> ,6 Lz zo ----- <br /> ZA ---—---On_------- - -__ - __ I --------- ---- -- ------------ ---- <br /> -------- --- -4-- - --------------------- --------- <br /> 4P------ -- ----- <br /> -- --------------------------- -------------- ----------- ... <br /> 4,19"------ ---------------- <br /> ---7,--w <br /> ----------------------------- <br /> ------------------------------------- ------------ <br /> ------------------------------------------------- <br /> -------------------------------- ----------------------------I <br /> - --------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------- -----------------------------------------­---------------------------------------------------------------------------------------------- <br /> PERMIT --------------- <br /> -------- ISSUED-------- -,2- <br /> .I.W-----------(Date) FINAL INSPECTION BY: <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ES-9-2M"' Stockton, California <br /> 9-50 W-1639;i <br />