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r <br /> APPLICATION FOR SANITATION PERMIT �O l <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 /> i. <br /> JOB ADDRESS AND LOCATION_____ Z--4--- _ <br /> --- -- - ------------------------- ---------(------------------- ------------------------ <br /> Owner's Name____ 1. _ - <br /> �"�,"� _ - ------------------- �------------------------------------------ Phone---------------------- <br /> Address___ / <br /> Contractors Narne____ 3 oL ti <br /> ----•- 1(r' ' q e <br /> �`'i' ---- Phone '!_` <br /> ---------- -------- ---------------------•-- - •-------------•- <br /> Installation will serve: ' Residence ' Apartment House ❑ Commercial ❑ Trailer Court 0 Motel [❑ Other <br /> Number of living units: Number of bedrooms Number of baths Lot size__Yj' __ _ f:(7_d__r______________________ <br /> Water'Supply: Public system�y Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe4 Hardpan ❑ <br /> i <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 from foundation--------------------Material__ __:________-_______________ <br /> 1❑ No. of coi-apartments______________ Capacity tY-----------------------Size---------------------...--------Liquid depth------------------------ <br /> cesspool: <br /> ------- -------------Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material-_____.__-------___.______ <br /> El I <br /> Size: Diameter------------------------------ ------Depth--------------I----------- -- ------------------------ -- <br /> Privy: Distance from nearest well_______________________________________________"_Distance from neares+ building <br /> ❑ Distance to nearest lot line________________________________________ ` <br /> L .Sege Pit: Distance to nearest -------Distance from ._. <br /> undation__-- Q_:__ Dis+ante to nearest lot line ___________ <br /> Number of pits-----l-------------Lining material__ ��1 _ _$ize: Diameter__. <br /> Depth a f--------------- <br /> Oisposal Field: Distance from nearest well_______________ Distance from foundation_____. Q____-__.Distance to nearest lot line__ __:___ <br /> Number of lines-------- ---------------____._ <br /> _L n th of h line______ _ ---Width of trench__________________ <br /> �,--,� i <br /> Type of filter material�„��,�� e�th ,enarraa'1'e�'ia"I___________ ----- <br /> Remodeling <br /> _ <br /> Remodelin and/or repairing 1(describe):________________ <br /> g / <br /> -------------------------------------------••----- r <br /> ---------------------------------------------------------- <br /> ------------ ------------------------ <br /> -----------------------------------•--------------------------------------------------•----------------------------------------- ----------- <br /> ---------------------------------------------------- <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, State law;, and rules and regulations of he San Joaquin Local Health District. <br /> (5i ned <br /> 9 ) Q4--------------------------------------------------(Owm"-and ar Contractor) <br /> By: +r!c' -----------`--------------------------------------------------(Title)--- <br /> of plans, showing size of[of,'location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FO. PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY______________________ '� <br /> - - -------------------------------------------------------- DATE------------ r <br /> REVIEWED BY - DATE . ---- ---- <br /> BUILDING PERMIT ISSUED---------------------------------- -------------------------- DATE <br /> ------------------------------------- --- <br /> Alterefionsand/or recommendafions_--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------ <br /> -----------------------------------------------------------------------------------------•--------------------------- --------- <br /> ------------------------------- -----------------•----------------------- <br /> -------------------------------------- <br /> ----------------------------------- - ------------------------------------------------------------------------------------------•------ ----------- --------------------- <br /> CC , <br /> PERMIT N -----f- ------- ISSUED------ _- _ .�_�_ _/_-fDate) FINAL INSPECTION BY:_____I1---------------------------------29 <br /> Date------------------- <br /> J <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />