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APPLICATION FOR SANITATION PERMIT <br /> Complete in Duplicate) t <br /> Local Health District for a permit to construct and insta44 the work herein described. <br /> Application is hereby made tb the Sin Joaquin i}�j <br /> This application is made in compliance with County Ordinance Na. 549. bb <br /> ------------ <br /> --- <br /> ------------ <br /> ------------------- Phone <br /> JOB ADDRESS AND LOCATIO _---,- <br /> -_. <br /> Owner's Name <br /> G�.�?' � ----------------------------------- <br /> Address <br /> --------------- - <br /> ,. Address-----------=-----------------------•---:°-------:----- - -- - - - - ----------------------- <br /> Phone_-- <br /> i Other <br /> - �__U__ `J4------- Motel ❑ ❑ <br /> Contractor's Name___-__-__ -- Commercial ❑ Trailer Court ❑ <br /> Installation will serve: Residence� Apartment House ❑ <br /> Number of bedrooms Number of baths Lot sae---------------- <br /> ------ --- - <br /> Number of living units: ❑ private ❑ t <br /> Community system ❑ �� Hardpan <br /> Water Supply: Public system ❑ Adobe P ❑ <br /> a depth of 3 feet: Sand ❑' Gravel ❑ Sandy Loam Clay Loam Clay ❑ <br /> Character of soil to P <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: /� <br /> -(No septic tank or cesspool permitted if public sewer is available within 200 feet.) E r-rL � <br /> 1�_------Material___`--`" -�-------�---------- <br /> %-.w <br /> Distance from nearest well_____ -----Distance from foundation_.___ -- - Li uid de th__-- -------------- <br /> Septic Tank: - v� Size-------- ____f_ q P <br /> Na of compartments-------------A_.------Capacity-----�- <br /> ------------- <br /> t <br /> Distance from nearest well________________Distance from-foundation___________--------.Lining material______--___.____--_---- <br /> Cesspool: - - <br /> ❑ Size: Diameter----------------------- Dept - s - n - from <br /> Priv Distance from nearest well-------------------•----------------------------- <br /> Distance from nearest building------------------------------------------ <br /> Distance <br /> ---------------------- <br /> y: <br /> ❑ Distance to nearest lot ine------------------------------------------------ <br /> ------------------------- - - ---- ------ " <br /> ----------Size: Diameter---------------------- Depth <br /> e�epag� pit; Distance to nearest well______________________Distance from foundation--------------------Distance to nearest of me______________ <br /> ❑ Number of pits---------------------- <br /> El <br /> material <br /> o .� <br /> 4. is osal Field: — D.istance�f.rom:nearest:well__."�^�--Distath of reach 1'neatian-.-- -----Wid Distain cof#tre chestyl�line:_ <br /> Number of lines______________`--$------ Length <br /> e th of #filter material-------!_ -----=- <br /> Type of filter materiaL______Y��--- p <br /> Remodeling and/or repairing (describe):------------------------------------------- <br /> ----------- <br /> ------------------------------------ <br /> ------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application he San Joaquin hLocal Heallth District. accordance with San Joaquin County <br /> ordinances, State laws, and rules a d regulations r <br /> --------------------(Owner and/or Contractor) <br /> [Signed) -- ------- <br /> Title)-------- <br /> - ------------------------ <br /> m m relation to wells, buildings, etc., mus} be filed with is application). <br /> (Piot plans, showing size of lot, location of syste <br /> FOR DEPARTMENT USE ONLY <br /> DATE----------- F ��------------------------ <br /> ---------------------- <br /> APPLICATION ACCEPTED BY------------ DATE--------- ------------------------------------ <br /> -- ------ --- --- <br /> -------------------- - <br /> REVIEWED BY ----- DATE_ <br /> BUILDINGPERMIT ISSUED---------------------------------------------------- -- -------------------------------- --------------------- <br /> ------------- <br /> Alterations and/or recommendations:------------------------ --------------------------------------------------------- <br /> - <br /> -------------------------------------------------------I--------------------I---—--------­-----------------------------------------------------------------------------------------1--1--_------�----------/---------------V---------------------------------------------_-------------------------------I------------------------------------------------------------------------------------------------------------------------------------I-------I---------------------------I------------------------------------­-.-1--------1--------------------3--------- <br /> ___ _________.__.__--- <br /> - <br /> - <br /> ------------------ ------------ <br /> iN � _----______(Date) FINAL INSPECTION BY:--------- -'--- -- <br /> PERMIT No. ISSUED <br /> ate------------------------------------------------------------------ <br /> ---------------------------------- - <br /> • <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES—•9--2M 9-60 W=1639 <br />