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i <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 Ordina No. 549. ` <br /> JOB ADDRESS <br /> ress <br /> ALOC-A- TI_O-- N..� -, - r�_ ------- ---- - --- ---- +- �} <br /> Owner's Name_- - ------------ <br /> � <br /> ` <br /> ------------ Phone_ <br /> Add ------------------ -------------- ` <br /> ------------------ •--------------- ------------ <br /> Contractor's Name---- __. Phone-.` "'..• _ .f_f <br /> Installation will serve: Residence [ Apartm House E] Commercial Trailer Court ElMotel [❑ `Other ❑ ��i <br /> — ki.�.—..i__ •..r i. . _ .. . . ...-. - . . .�- v _ - .- _ my _ .. . �1 <br /> Water Supply: Public system 2-1--ommunity system E] Private ❑ Depth to Water Table 4 'ft. <br /> ­;1 4— - A--" -s-,2 s....;. (z...4 r� �(;.�....I_f-1. .C�..,J._. I ,.�...-I-1. (`I>.. I ....... 1-1 r-1.... r_1 ,. A-1—.... <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ .Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,W Hardpan ❑ 1 <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__-___---Distance from foundation-- -___.___.Material..--__60-sR,, t�, �' <br /> No. of compartments I Capacity `S ....Size-----------=-------- Liquid depth------------------------ f. <br /> Ce?Spool: Distance from nearest well_________________Distance from foundation <br /> -------------------- material------------- <br /> _______- "_--_-_ E <br /> ElSize: Diameter---------------------------------------Dep th... ----------------------------------------------- " <br /> Privy: Distance from nearest well ____ ______ ___ -___._Distance from nearest building ------------ <br /> ❑ Distance fo nearest lot line-------------_____._"--.------_________"---____ <br /> Seepage Pit: Distance to nearest well---------------------- from f ndation__------_____--____-Distan e to nearest lot-line_---/ �_-_ <br /> ,� Number of pits_.______1---___-__-Lining mafierial ___Size: Diameter___.._-.-..�A___------Depth___dat—A- <br /> Disposal Field:. Distance from nearest well------------------Distance from foundat • --.Distance to nearest lot line-------- <br /> Number of lines------------ - ---------L__Length of each line- Width of french----------�!------------------ <br /> Type of filter materialf� --_V ------Depth of filter materia-__"---_ ' T <br /> Rempd ling`and/or repairing (describe):-- --__ � _e _ - ---1-------odd(----t -: _ <br /> : -y ----------------------------------------------------- • U <br /> ------ <br /> -------------------------------------- <br /> _-_____---_ _____________________ F <br /> hereby certify fhat i have prepared this application and that the work will be done in accordance with San Joaquin County, <br /> ordinances, St laws, and rules and r ula ' ns of the Sa Joaquin cal Health istrict. <br /> (Signed)........ - ---- <br /> -------------(Owner and/or Contractor) <br /> Sy:------- --- --------- - ---- y Title= s � <br /> (Plot plans, sho size o ot, f n of s ste in re ation to wells, buildings, efc., must be filed with this application). y <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ - DATE___) __ S _- <br /> REVIEED BY-_ _ ------ '---- ------ ,DATE-----J= <br /> ------------------------------------------------------------ <br /> UILDING PERMIT ISSUED--------------------------------------------------------------- ------- DATE <br /> ------------------------------- <br /> Alterations and/or recommendations_________________________ <br /> -•------------------------------------ / - /--------------------------•-- ------------------- - <br /> ��" `° Pic rD �f f± f✓r _C_ P•�f3! S/s_J` ------- -- ----•----------- --•------------ 4� <br /> l <br /> € ----- <br /> ---------------------------------------- <br /> . <br /> PERMIT ._._--Vb_S--__------ I ED------U-'15r-__S-�----------------(Date) FINAL INSPECTION ,BY:---___.�----� i <br /> * Date 'S C1 <br /> SAN'`JOAQUIN LOCAL HEALTH DISTRICT <br /> ` 130 South American Street <br /> ie + <br /> ES-9-2 M 9-50 W=1639 Stockton, California " <br />