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APPLICATION FOR SANITATION PERMIT 3 P <br /> (Complete in Duplicate) <br /> #�'T nfo j(_ 2fi%h1s� for 2S�'- 3�O�2c3 <br /> Application is hereby meds o the Sen oequin Local Heelth Dis rict for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. SE <br /> JOB ADDRESS AND L C TION...__ ._�✓ ___ .. ---------- . ..... .... .... . .. . <br /> Owner's Name------ -- ------ '-`----"C/2f!-�iU-----------------------------—_.._..._._.....—'Phone------ <br /> Address......-...... <br /> - - -----2 ------------------- --•----------------------_- ----------- <br /> Contractor's Neme___ Ri1l _...._..._ Phone-_......._____ <br /> Installation will some: Resident Apartment House ❑ Commercial Ef Trailer Court ❑ Motel ❑ Other ❑ <br /> er of living units: [� Number of bedrooms�j Number of baths V Lot siz9_ ­ <br /> Numby J <br /> ------------------------- .L! <br /> Water Supply: Public system ❑ Community system ❑ Private X 4�9�.� <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay (� Adobe ❑ Hardpan Q <br /> TYPE Of INSTALLATION AND SPECIFICATIONS: ` X11 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a <br /> Septic-Tank: Distance from nearest well 2A,-_from oundation__._1Q--.Material___.��---f'!�!S- -_..___.- <br /> No. of compartments..__---_---.y_...Capacity---_.-�QQ...__Sizejl)(57�. .__Uquid depth---_.- ..y._..... <br /> Cesspool: Distance from nearest well........_...Distance from foundation---..___.....:..Lining materiel-_........_........ <br /> ❑ Size: Diameter--------------------------.....Depth.............-...' - ------- <br /> Privy, Distance from nearest well............................................_...Distance from nearest building...................... <br /> _....____._ <br /> ❑ Distance to nearest lot line-------------------------_.----_---_----_ I <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 /> Dispo;al Field: Distance from.nearest well-- -A....Distance from foundation.._........Distance to nearest lot line, <br /> /1p{` Number of lines.......___.. ......... ...... Length of each line______�.� y Width of trench_.....;zI".....__....... <br /> tt r <br /> Type of filter ma+erial..,j�„[�OAr1CDepth of filter material.... .. ........_ <br /> Remodeling and/or repairing (describe)------ ..............................................--..........---- —------- ---•------ <br /> ----------------------------I------------------------ -----------------____.....__.......•_-----------------------------------........_ ----------------------------------..._-------------- <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 Contra <br /> By:. .- c!^- ---------._............... --------(Title)------... ------...........------ . _ ...... - _ <br /> (Plot plans, showing ' e of lot, location of system in relation to wells, buildings, eta, must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -' ..............I....-"............... DATE---- _._....__ _.. ._....... <br /> REVIEWED BY--------.... ...._....... ................ DATE__ .f <br /> BUILDING PERMIT ISSUED....____-..._.-_-- -------.----------- ---_--------.----_--_._ DATE_._ --- -_- -- <br /> Alterations and/or recommendations:----.......................................................-'-.......---"----•--------------------•----'----•----..-------'----......---'---- <br /> --------------�---- --- --- - .........................--------__------.--_-------_.._._...- _........_...................----.. <br /> ..........-.....-.........._.._......... .._...__... ._ <br /> PERMIT No.s ..7 .�_ ISSUED.... -y..� (Date) FINAL INSPECTION BY:...__..._.. _._.. ....... <br /> Date <br /> v- Q <br /> Date--------------------- "---N..I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-21M 9-SO W4639 <br />