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..i- s <br /> 4b <br /> 4 APPLICATION FOR SANITATION PERMIT / <br /> (Complete in Duplicate) 7 <br /> Application is her 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--- ° lljof*',A16-rs�/ � <br /> - ------ - ---------------------------------------------------------------------------------- <br /> Owner's Name--------�ry_��-��� T� <br /> ----- - � <br /> ,. I ------------------------------------------------------ Phone--------------------------------Address ------------- _s�TI 404--------------------------- <br /> Contractor's <br /> ------------ - - _ • <br /> - - ---------- -- <br /> •----------------------------I----------------------------------- <br /> Contractor's Name--------•-----------•-----_--'- - <br /> ---- --------- - -------- --- --•--- ---------- Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel <br /> y-- ❑ Other ❑ <br /> Number of living units: E]/Number of bedrooms ❑ Number of baths ❑/Lot size----___-- !t �` <br /> Wafer Supply: Public system [Community system ❑ Private ❑ Nlkl <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] 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 fee}.� <br /> Septic ank: Distance from nearest well____X __,Distance from foundation_.___-_-__.Material-___- ►/ '�� <br /> No. of compartments---------------,�-y--_Ca acit _ Op_ i f <br /> P Y `� . Size-------�- -'-----Liquid depth------- : <br /> Cesspool: Distance from nearest well-----------------Distance fr4bm foundation---------------------Lining material-------------------------- ---------- <br /> Size: Diameter-----I--------------------------------Depth-------- ------------ - <br /> - ---------------------------- <br /> ---------- <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 /> :D. <br /> Number of pits------------ ----L� material-----------------------Size. Diameter----•-----------------Depth--- ------------------- <br /> Dispos�l Field: Distance from nearest well____-_____---___.Distance from foundation-- -._----_-_ -�T <br /> d Len Length of each line-_- _`- -� -- Disfiance.to nearest lot line_________________ <br /> Number of lines-__-____3 - <br /> �J a ,ng � `� -$.Width of french------- ----------------------- <br /> Type of filter material----®ir �Xpth of filter material--------- e--,- <br /> Remodeling and/or repairing (describe)------------------------- <br /> �x- --- <br /> ---- - <br /> 0 t 4---------�'F- P- - Q_4)-M l x .� <br /> ------- <br /> -----------------------------------/ -AA.-s.._ ,n-------ef --------9�,o � <br /> ------------------------------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sfafe laws, d rules a d' 'rep4ations of a San Joaquin Local Health District. <br /> (Signed)- h +r <br /> --- <br /> By. - � --(Owner and/or Contractor) <br /> -------- --------------------------------- ---------------------------- ------ -- - --- ----------------(Title)---------------------------------------------------------------- <br /> (Plot plans, showing size of lot, location'of system in relation to wells, buildings, etc., must be fled with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------- -----e/ <br /> DATE <br /> REVIEWED BY 27V <br /> - -------------- <br /> -------------------------------------- DATE <br /> Q -" <br /> BUILDING PERMIT ISSUED---------------- I----_---_ <br /> Alterations and/or recommendation --------------------- -- --- DATE-_-_--_-__--- -- -- <br /> -,_S l ---------------- ---- -------------------------------------------------------------------*----------------­-_ <br /> -- <br /> - - -- -------------- <br /> ------- --- . ---------------- <br /> -------------------------------------------------'-------------------------------------------------------------------------------------------- <br /> h ` <br /> -------------------------------------------- <br /> � - ------------------ <br /> PERMIT No. 3--- - -------- ISSUED--__3 <br /> ----------------------(Date) FINAL INSPECTION -BY: <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-7-2M 9-50 W=1639 <br />