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37Y <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 /> JOB ADDRESS AND LOCATION--------- -------1------- L D L� ---------------------------------------------------------------------------- <br /> 'foOwner's Name--------------------- 'K --------------------------------------------- ne--------------------- <br /> Address-...------------------------------------ --------------------------------------------------------- -------------------------- <br /> -Contractor's Name---------------- lile' .�--------- 4 u jl[A— c-c..rJ ------------------- Phone----- <br /> ----------------------------------------------------------------- <br /> Installation <br /> --------------------- <br /> _Installation will serve: Residence Z/Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: � Number of bedrooms El Number of baths [� Lot size----_-___l:�-t'__-----------------------------------��' - <br /> Water Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 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 fr fou dation----h-_______-.Material_.__--_-_-___________.______.____.:__________--- <br /> No. of compartments--------------------------Capacity_. Size-:-- '-- �4- _--Liquid depth-------------------__---- <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-----------______--_----_-____.___-- I <br /> ❑ Distance to nearest lot line______--.__________________---_----______-____Seepage Pit- Distance to nearest well_____________________Distance/rom foundation--_/�__..--___.Distance to nearest lot line_..- ...Number of pits----_.____________Lining material__"+"_-�- --.Size: Diameter_3_��______--_--Depth.__4''1-'____________________Disposal Field: Distance from nearest well__-.__________-.Distance from foundation_--_---__________._Distance to nearest lot line____-__----__-I] Number of lines________________________________Length of each line____---.-_._____-____.______.Width of trench--_-______--__---___-_-__-_-----Type of filter material________________________Depth of filter material_-------.___----__-__-_Remodeling and/or repairing (describe):------+---- -- --------------------------------------------------- -•------------------------------------------------------------ <br /> -------------------------------------------------- ------�- ------------------- ----------------- - ------------------------------- <br /> f ------ <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 la fanules. andr&ations of the San Joaquin Local Health District. <br /> (Signed)----------- -----` -------------------------- ---------------------------- --------(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 /> REVIEWED BY ---------------------------- DATE---- --- V'y ------------------------------------------ <br /> - <br /> BUILDIN <br /> ---- --------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------- --------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations---------------------------- --- ---------------- -------- ------•--------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------- ------------------------------------------------------------------------ ---rr---••--II------------------------------------------------ <br /> PERMIT No._.--3-�.�----- ISSUED____-3�1_,f-"J ----------(Date) FINAL INSPECTION BY:--- _--__�1---- ___ <br /> Date----------------------- --------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />