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f <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 Ordinance No. 549. <br /> JOBADDRESS AND LOCATION v' - =------------ '-=------------------------ " f-- ------------------------------------------------------------------------------ <br /> Owneris Name---- .... r:., 5 - !..\ :y ,F _-- Phone ==-`------------------------- <br /> ---------- '�=�-= a"' <br /> ------------------------------------------------- <br /> -Address <br /> Contractor's Name---------- =' '- ----------------------------------------------------------------------------------------------------- .._. Phone----------------------------------- <br /> Installation will serve: Residence 51Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -❑ Number of bedrooms [j Number of baths m Lot size____________________________ \ <br /> Water Supply: Public system ❑ Community system ❑ Private [0 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe P Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> - Size---'-'- <br /> ; <br /> �. P Capacity -----------Material------- <br /> Septic '` = <br /> No. of compartments ___-_____Ca acs K <br /> Tank: Distance from nearest well ______.Qistance from foundation__..._ -•��� �, �-_ Liquid depth_____:_'_`______________. '. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> 0 Size: Diameter--------------------------------------Depth-.------------------------------------------------- <br /> Privy: Distance from nearest well________________________________________________Distance from nearest building------------------------------------------ <br /> F 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 /> Qisposal Field:"," Distance from nearest well------'-4,._____-__.Distance from foundation_____-__..___..Distance to nearest lot line_________________ � <br /> [* Number of lines------------I---------------------Length of each line_-__r r? ;_---- -_`.=---------Width of trench------�_�'_.___________------- <br /> Type of filter material__``__-''____°'__:_______:_Death of filter material________e°_____________ I <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)------------ ---------=--------------------- --------------------------------------------------------------------------------------------------------------------[Owner and/or Contractor) <br /> By :-___ XR-.--------------------------------------------------------------(Title)_____________________________-__--.-_____________ -------------- <br /> (Piot 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 /> BUILDINGPERMIT ISSUED---------------------------------------------------------- --------- --------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:-----3_..f•, ,--/----------• ar t_ t ___ti ---lit <br /> ----------------------------- ----------------------------------------- <br /> I <br /> ----------------------------------------- =---•------------------------------------------------------------------ . ,-r�v s _ <br /> ---------------------- ----------------------------- ---------------------------------------------------------- {' Q 1 _('6-({--------- -------Y_ <br /> PERMIT No.- ISSUED--- ./ -- -- - ------------ I f L " <br /> Qate FINAL INSPECTION BY <br /> Date------- F x- ---------- ; <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street r <br /> Stockton, CalifgWa 'r `-k' <br /> Es-9-2M 9.50 W=1639 �' <br />