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r APPLICATION FOR SANITATION PERMIT <br /> a r <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 <br /> �Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__________ -^�0 ' e� <br /> - --------- -------_9/--------------------------------------------------- <br /> /V <br /> ------------------ --------------------------------------------------------------------------------- <br /> �'O IP7`I Y /1� - Phone---. 3 3 <br /> Owner's Name--------------------------- ------ <br /> ------------ <br /> Address :3--G %ro --v�--- ----- p----k-------------------------------------------------------------------------------------------- <br /> Contractor's Name----------------------------- ----------------------------- - Phone <br /> 1_7 <br /> Installation will serve: Residence MApartment House ❑ Commercial 0 Trailer Court ❑ Motel [I Oth/er❑ <br /> �Number of living units/ Number of bedrooms � Number of baths Uf Lot size_____ ____ `------------------------ r <br /> Water Supply: Public system e Community system ❑ Private ❑ `y <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay E] Adobe <br /> d Hardpan [ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: D` <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_S'Q______-_Distance fro foundation___________________Material_______________________ -_ _ ____.____ <br /> [� No. of compartments------------ -- rze _X-'rX_4- Liquid depth______ ---------_---- <br /> ,�'---------Capacity - o 0 9 <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--_.____________________---______________ <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 /> __Disposa Field: Distance from nearest Weil__ -------.Distance from foundation__ ----------Distance to nearest lot line____"_______ <br /> [, Number of lines----.___--x' .--_-- - Length of each line----------------�sr-------Width of french-----�''�'-�--------------- <br /> Type of filter material____ �42GG-4epth of filter material___,_ ?_ ______ <br /> Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------- <br /> ---------------- <br /> _­_11-------------------------------------------------- -------- <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 aregulations of the San Joaquin Local Health District. <br /> (Owner and/or Contractor)(Signed)- <br /> Title <br /> r (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 /> BUILDINGPERMIT ISSUED------- ---------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations:-----------------------------------------------------------------------------------•-------------------------------------------------------------------------- <br /> -•---------------------•-------------------------------------------------------------------------------------------------------------------------------------------I-----�---- <br /> PERMlT No. ------- - --------(Date) FINAL INSPECTION BY:------"------------- ------------------------------------------ <br /> Date----------------•------- rs` ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9--2M 9-50 W-1539 <br />