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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicalef <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 applicatio3is-made in compliance with County Ordinance No. 549 W .� <br /> JOB ADDRESS A�D_ LOCATION.--.- _ = - -` -------•---------------- ;t <br /> VO <br /> Owner's Name - _,.. - ............ ...........---•----- ------------•----•-•----•-----:----------------- Phone- - <br /> Address...............................---------- ----'................................... °5..... = - `. <br /> Contractor's Name......-.....-............ &W- . Phone..... �* <br /> - ---------•._._........ <br /> Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ MMotel ❑ Other❑ <br /> Number of living units: A Number of bedrooms d Number of baths ❑ Lot size._:_.__._!Pa_ ._...!'C� <br /> Water Supply: Public system KeCommunify system ❑ Private ❑ <br /> Character of soil to a depth A 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay❑ Adobe IpJ Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Of F�-trJ a 0,o <br /> Septic ank: Distance from nearest well__.��_____Distance from foundation__".��.' ..........Material__._._____..�................... ..v_..._.._. <br /> No. of compartments-----__-_Y_....._..__Capacity---_-•----------------- ......-.....Liquid depth------- •------•---- <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material...................................... f� <br /> ❑ Size: Diameter-----------•-•-......................Depth---------------------------•-----_--............. t <br /> Privy: Distance from nearest well.................................................Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line................................................ <br /> F Seepage Pit: Distance to nearest well......................Distance from foundation......._............Distance to nearest lot line-------......... <br /> ❑ Number of pits-----_--------------Li/ning material-----------------------Size: Diameter...........-.._.......Depth.......................-. y__-- <br /> -rat7� <br /> Disposa ield: Distance from nearest well..........:......Distance,from=foundaf•ion_-:._;, f:.:--'-D.istancee to.near-est lot-lin . ....... <br /> . <br /> - - <br /> - Number oflines__----------..-- •-------------Length of each line.---.....74---------------Width of trench----_-_- ---._...___-._- <br /> Type of filter material-------.---------........Depth of filter material....................:.. <br /> Remodeling and/or repairing (describe);------ ............................................ <br /> /ii�('" `•�--•---:-----•-•--••--•--- ................-.----- C4 �--••. <br /> ------•-----• ---------=---•••---•----. . V ...�-•--- J&----••----: _ .......... . <br /> ...........-•--...-----•-•-•-------..............._....................................................................................................................................................-----------------. <br /> -•---••-----------_--•••----•---.....----••--•-••-•---••••-•-••..........--•----•...................•...---••-•--- .......-.....---------_---................................••-•-•---•-•--- ......-•--.......... <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Courrty <br /> ordinancok, State laws, and rules a regula ' ns f the San Joaquin Local Health District. <br /> h <br /> (Signed ......................... ............Ir------------___.....................................................(Owner and/or Contractor) <br /> ` y:--- -- ------------- -•(Ti+1e) <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 /> . i <br /> APPLICATION ACCEPTED BY..................... DATE........t --- �------ <br /> REVIEWED BY - - DATE -• •--•--. <br /> BUILDINGPERMIT ISSUED............................. ----_----_--------------------------- ------- ------- DATE..--------•-----••-----•-••-----............................ <br /> Alterations and/or recommendations:................-----------•--..................... .............•.............................................................................. <br /> .............................................................----------------------------------------------------------------•--------------•------------------------------------------------------=--------------------- <br /> -•-----------------....................................-................................ .....------_---------•...................................................--............................................ <br /> ------------------------------------------...........................................-----------••-----------------------------•-•------------.....------------------------------....-•------'--------- ------ ' <br /> ------------------------------------------------------------------------------------------------•-------------------------------------------------------------------•--G�"'` ...------------------------------�, <br /> ,,.. <br /> PERMIT No.___. rj'_'_,-_.R__ ISSUED.-_�_'-�."5. .- _..... ___.....(Date) FINAL .i,ISPECTION BY:._ <br /> Date--- l� .G� ............... _..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street ? <br /> Stockton, California r <br /> ES--•9-2M 9.50 W.1639 <br /> • I <br />