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3G6 <br /> . >! APPLICATION FOR SANITATION PERMITS -�-- <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. 549. <br /> JOB ADDRESS AND LOCA,�TI+ON ' <br /> Owner's Name----------------------- iP �l�' � ,L' O STT, <br /> --- -- --------------------------- --------------.-- Phone------------------------------------ <br /> - -- --- - --- <br /> Address-------------------------------- 6— )�- / >' - "T. <br /> ------------------------------------------------------------------------------------------ <br /> Contractor's Name------------------------------------- W <br /> -hs Phone <br /> ------------------------------- ----------------------------------------- ------------------ <br /> Installation will serve: Residence Apartment House Co7mercial ❑ Trailer Court ❑ Motel [] Other ❑ <br /> Number of livingunits: Number bedrooms [ Number of baths ❑ __X__ .r--------------------_----- <br /> ❑� /Lot size--------------- <br /> Water Supply:r Public system e ,Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <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 f� p <br /> m foundation___._y_s� r ----------------------------------- <br /> rial ,--.____-___ <br /> E No. of compartments-------Y------------- <br /> Capacity- _ __c___�-__ .ize_LCz-J�tP_ _ _____Liquid depth__----- ---_ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------ Lining material-------------------------------------- <br /> 0 <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----------------------Distance from foundation___.____ ______Distance to nearest lot line_________________ <br /> ❑ Number of pits----------------------Lining material---------------------..Size: Diameter-----------------------Depth---------------------------- _-- <br /> Disposal Field: Distance from nearest well------------------Distance from foundafion-___ Distance to nearest lot line.__'___,_ <br /> Q' Number of lines_____________/----__. __-!Length of each lire___-_-- - _u_--------Width of trench,_____ ..__ __ `f_ --_------- <br /> Type of filter material_ r j! _bepth of filter material-_-le- --------- <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)Z- ' a1f ` _ ---------- <br /> ------------------(Owner and/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 /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- ---------- ---------------------------------------------- DATE-------- <br /> REVIEWEDBY---------------------- ----------------------------------------------- ----------- ------------ DATE------ • = <br /> BUILDING PERMIT ISSUED-------------- __ DAT _ _, <br /> Alterations and/ r reco men atians:-_- - �- ----_--_ _--- _ ---- <br /> t // <br /> ---------------/ < - ------------------------------------------------------- - - -- <br /> -------------- !¢------------- - c <br /> ------------------ •-- ----------�----------------------------------------------------------------•------------ <br /> ----------------`- ,s�-----------------�` -' '---------5i--- c- �.----- <br /> PERMIT No._` _6--------- ISSUED----- - 1-_ ------------(Date) FINAL INSPECTION BY:--------- <br /> ---------------------------------- <br /> Date---- <br /> ------------------------- <br /> Date---------- ------- C- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> k <br /> �-4-2M 9-50 W=1634 Stockton, California <br /> \f � i <br />