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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 de cribed. <br /> This application-is-made,.in_com liance with Count Ordinance No. 549. <br /> EAJ <br /> JOB ADDRESS AND LOCA ON -- �%T .e�t <br /> Owner's Name--- ° - -- -�' ! ry------�--------------------------------------------------------------- Phone f__AL q - ---------- <br /> Address-------------- 1 -------------- ------------------------------------------------------------------------------ <br /> Contractor's Name-------?----------- ------------ Phone----------------------------------- <br /> -------------------------------------------------------- <br /> --------------------------------------------------- <br /> Installation will serve: Residence I ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: © Number of bedrooms M Number of baths ® Lot size_jpQ_`__/s- --- --------------------------------- <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 ❑ Ha�dp�rr 0'� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1' <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-_____-____-_--________----________-_-_-___--.. <br /> --------Capacity-----------------------Size-------------------- <br /> ❑ No. of compartments------------- -- -----------------------------_Liquid depth-------------------- <br /> Cesspool: <br /> ------_ -- -. <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 /> ❑ Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well__________________ <br /> _--Distance from foundation--------------------Distance to nearest lot line---------------- <br /> ❑ Number of pits------_--------------Lining material.-.--------------------Size: Diameter-----------------------.Depth----------------__------------- <br /> ,-Disposal Field: Distance from nearest well_!;!��q----.Distance from foundation____"_'0----------Distance to nearest lot line--- ___-__-__ <br /> Number of lines------I-------------- _ _________Length of each line------ ------------------Width of -------- <br /> Type of filter material-__+t �v__'_-._Depth of filter material----I_-______________ <br /> M <br /> -Remodeling and/or repairing (describe)--------------------------------------- ----------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------- <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 /> ---------------------------------------------------------------------•--(Owner and/or Contractor) <br /> [Signed}__ �-t.�}_--- ------------�..�1 _ <br /> Tale T <br /> By:--------------------------------------------- ---- -------------------------------------------------------------( � )------------------------------------------------- <br /> -(Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY---------�.------ �r.±r------------------------------------------------------- DATE---- R- Y-=rZ------------------------------- <br /> REVIEWEDBY------------------------------------- ------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------- ---- --------------- DATE----------------------- ------------------------------------- <br /> Alterationsand/or recommendations----------------------------- ------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------•------------------------------------------------------------------------------ <br /> ------------- <br /> PERMIT No------10-` ----- ISSUED----} -5 -------------(Date) FINAL INSPECTION BY:--.- - ----------------- <br /> ------------------------------ <br /> SAN <br /> ---------------------------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />