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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 Orclinanc r No. 549. <br /> JOB ADDRESS AND LO ATION----,1 O 1 ------ - - -- - ---------- �'.-------------------------------------------------------------------- <br /> Owner's Name--- Phone <br /> ------------------------ <br /> ~-------------------------------------------- <br /> ------------------------------------ <br /> Address. <br /> Contractor s Name__.D- ��v <br /> .�1_ '--- p —--------- r,-Q <br /> -- -`-- -- - - - -----------� s -----------------�_ Phone--�------ ---------• <br /> Installation will serve: Resident Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number-of living units: ._ Number of bedrooms of baths Lot size---trD--_--, (___�__ ___..__-___________ <br /> _ -Number <br /> Water Supply. Public system )e <br /> Community system E] Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe Hardpan11, <br /> �A <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: `l <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___ <br /> No. of compartments--------2---------Capacity_____�0'4____Size_.,,j�__ _, -------Liquid depth__ 67z ----- <br /> Cesspool: Distance from -nearest we1L________________Distance from foundation--------------------Lining material-------------------------------------- <br /> ElSize: Diameter--------------------------------------Depth--------------- ----------- --------------------- <br /> 'Privy: Distance from nearest well__________________________________--________----Distance from nearest building_-_---------_----________________--____. <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> we <br /> See aqe Pit: Distance to nearest well_ ___._ Distance from fo ation___-__ <br /> P� --�--�--- � _--------Dis+ante to nearest lot line-__,,1�______ <br /> Number of pits-_--�-------_Lining material_ ,Size: Diameter__.3�`�___-_-.Depth _ ----------------- <br /> ..-Disposal <br /> _________---- <br /> e <br /> Disposal Field: Distance from nearest well___---------------Distance from foundation-----jQ_ _..Distance to nearest lot <br /> Number of lines------------ k/�r- r_�_j Length of each line-----3Q_--------------Width of trench---- <br /> ____ <br /> Type of filter material_- _WT.--Depth of filter material------- 8"______ <br /> Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------•--------------------------------------------•--•--------------------------------------------------------•--------------------------------------- <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 /> ordinances,State laws, and rules and regulations of the San Joaquin'Local Health District. <br /> (Signed)--•- `VI_A_ --- t t " ` ---------------------------------------------------- ( "a&L aad/or Contractor) <br /> BY� (Title) ------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- <br /> - DATE ------------ <br /> REVIEWEDBY--------------------------------------- --------------------------------------------------------- --------------------------- DATE----------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE <br /> Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------• ------•------------------------------•-----------------------------------------------------------•------------------------ ------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------- <br /> PERMIT No.___\Ekl)-�------- ISSUED--- ------------------(Date) FINAL INSPECTION BY:--------- ---------------------------------------- <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 />