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APPLICATION FOR SANITATION PERMIT j- 7 <br /> (Complete in Duplicate) Or <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 OPPlicafion is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATI-2 ? <br /> >----------------------- <br /> ----------------- <br /> OZO <br /> Owner's Name------ --- --- ---------------m�-------------- -- -- ------------ <br /> Address--- �------ ----- o� <br /> � ---------11- __�-----40.4-no, - ------ <br /> Phone <br /> Contractor's Name_ le-*y---------- <br /> Installation will serve: Residence JK Apartment House Ej Phone---9:77214J�7 <br /> Number of bedrooms ❑ <br /> Number of living units. Commercial Ej Trailer Court ❑ Motel 0 Other <br /> Wafer Supply: Public sysfe 5h Number of baths 0 Lot AP <br /> Community system.E] ------------------------------ <br /> MIX : 'Private <br /> Character of soil to a depth of 3 feet: Sand ] Grave) 0 Sandy Loam 0 Clay Loam E] Clay 0 Adobe Hardpan Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or Cesspool permitted if public sewer is available within 200 feet.) <br /> Se f' Tank: Distance from nearest we))_--���Distance from foundation______9 <br /> PR No. Of compartments---------0?_ -------Materiai <br /> Cess pool: ..............Capacify--R-O 0-------Size-- ---- ------ <br /> 'X-y--�-Li <br /> 4-------Liquid depth___--: <br /> Distance from nearest Weil-----------------Distance from foundation-------------- ing material-------- - ------ <br /> ❑ Size: Diameter--------------------- <br /> ---- <br /> iannefer--------------------------------------Depth------------------------- -------------------------- ------------------------- -_ <br /> Privy: Disfance*from nearest welt-------------------------------------------------Distance from nearest building----------- <br /> ri Distance to nearest lot line <br /> Seepage Pit: Distance to nearest well-—------------------------------ <br /> Number of pits________!_---_--------------------Disfance.from fo� afion----- Distance to nearest Jot line---- <br /> ------Lining maferial__A4 IT 91 <br /> 41? <br /> .Disposal Field: A W-Size: Diameter---- <br /> Distance from nearest well-'-'-Distance from foundation----1�f ---------------- <br /> Number of lines------------e--- ----------Length of each line -0--------Distance to nearest lot line-----S"'I <br /> Type of filter maferial--y ---------P0----t--------Width of french -- ------ <br /> Depth of filter material --------,-- ------------------- <br /> -Remodeling and/or repairing (describe) <br /> --------------------------------------------------------------------------------------------w---------------------------------------------------------------- <br /> --------------------------------------------- ------------------------------------------------i_�------------------------------- - ------------------I-------------------------------- <br /> ---------------------------I----------------------------------------- application <br /> ------------------------------------------------------------------------I---------------------- <br /> I hereby certify that I have prepa a.-d----f_hr_sap---plica------------------------------------------------------------------------------------------------------------------I-------- <br /> flon and that the work will be done in accordance with San Joaquin Cou-n-fy <br /> ordinances, State laws, and rules and' regulations of the San Joaquin Local Healfh District. <br /> (Signed)---- -- - <br /> By:--- -------------------------------------------------------------- -(9W"8_r-"Qd/,pr Contractor) <br /> - -- --- --- <br /> -------- (Title)_ . 110h <br /> (Plot plans, showing size of lof, location of system in rel--- 7------- -------------------------------------------- e 4 --41194-L,------------------------- <br /> afion to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> -APPLICATION ACCEPTED BY <br /> REVIEWED 8Y_ '. __1------------------------------ DATE <br /> -------------------------:------------------------------/W--------------------------------------- <br /> BUILDING PERMIT ISSUED ------------------ DATE------ - ---- .. <br /> Alterations and/or recommendaf ions: -------------------------?------------- DATE-------------- <br /> --------------------- <br /> ATE-------------------- I------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------­------------------------------------------------------- I- ---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I-A------------------ <br /> (Date) FINAL INSPECTION BY:------- <br /> ------------- -- ----------------------------------------------------------------------------------- --------- - <br /> PERMIT No.��72 .5— ISSUED---- <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> E5--9-2M 9.50 W-1639 Stockton, California <br />