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3/ <br /> 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. 544. <br /> JOB ADDRESS AND LOCATION _-__ ----------- <br /> - -7_�--i_ _____ -A-k-1_ <br /> -------- -- ------------------------------------------------------- <br /> Owner's Name-------------------- ' r�' - Phone _1_1511-9 <br /> Address-------------------------------------------------------------ZZ-z------ <br /> Contractor's Name-------------------:------- x`171/ <br /> - --- - ------------------------- Phone <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: [21, Number of bedrooms 2— Number of baths Uf Lot size------------�-6__'�_X____�2------------------------- <br />{ Water Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe 0 Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu6lic sewer is available within'200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material___________---------______-____-_-------__-__-__. Q <br /> No. of compartments--------------------------Capacity-----------------------Size----- --------------------------Liquid depth--------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__------____-_.__________---__--__-. <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-_---_----------_______________-___-_. <br /> ❑ Mstance to nearest lot line_________________________________-__-__---_____ <br /> Seepa Pit: Distance to nearest well_ `' "'"cam` _Distance rom foundation___ y_______-Distance to nearest lot line j____�______ <br /> [+ Number of pits-------I-.-____ Lining material___- "�. -;--Size: Diameter_.__________________Depth_______ __________---_____ <br /> Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line_-_--_-_-__-_____ <br /> i <br /> [� Number of lines------------- --------------------Length of each line--------- -----_-_-__-.Width of trench-----,'-----.--------__--------- <br /> /- ' N <br /> Type of filter material_ !€�:4 ' -__Depth of filter material______--- ----__ <br /> .Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> = = .. ------ -------------------------------------------------------------------------- <br /> ---------- <br /> �------- - - <br /> 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 and regulations of the San Joaquin Local Health District. <br /> (Signed)-- �r � R -----------------------------------(Owner and/or Contractor) <br />' By:---------------------- P �`_ ------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plans, showing sizeo ,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------------- fi _ DATE----.____ <br /> REVIEWED BY - ) <br /> .•- ----- ------------------------------------------------ DATE---------- ---- - <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------- <br /> Alterations and/or recommendations ------------------------------------------------------- <br /> ? �- `CTM-------------E T-----��------�"�- _-- ------------------------------------------------------- --------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- <br /> i <br /> PERMIT ----------- ISSUED__ ____ __ ______ -------.---(Date) FINAL INSPECTION BY:---- ___ <br /> ---------------------------------------- <br /> �-/a'7 <br /> Date------------------------ --- -------------------------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />