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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> This application is made in compliance with County Ordinance No. 549, k herei—0 2 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal] theworo I d?n described. <br /> JOB ADDRESS AND LOCATION__tY0__te_th_. <br /> ----e--n-4-----g- -91,71 -7 <br /> ------------------ <br /> Owner's Name.---- <br /> ------------------------------------- Phone-------------------- <br /> Address----------- <br /> A---- -- ` i-------__�-----------------------------I--------- <br /> Contractor's Name ----------- Phone <br /> - <br /> ---------------------------------------------------------------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial [] Trailer Court E] Motell, <br /> El Other El <br /> Number of living units: N,mber of bedrooms a Number of bafhs _�,�_40.Lot size_ . `j- _ Z_7�1 <br /> 14 a AO <br /> ------------------ <br /> Wafer Supply: Public system Community system El Private F 7 <br /> Character of soil to'a depth of 3 feet: Sand El Gravel E] Sandy Loam E] Clay Loam 4 Clay ❑ Adobe E] Hardpan 0 <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--,--i �k <br /> No. of compartments--------------------------Capacity-----------------------Size-- .............. <br /> -_---------------------------Li�uicl depth------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material--_________-___.-_____-_Size: Diameter-----I---------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well_____________________________ ________Distance from nearest buildin• g----------------------------------------- <br /> Distance to nearest lot line-________------- j <br /> 1. -----1'-%_00VI-_ 11 <br /> Seepage Pit: Distance to nearest well- �"—D_is`ta`n�c� from f6undatio Distance to nearest lot line--- <br /> ---- —------Lining material.O-A�- --- ---_Size: Diar�eter---,-i-'A---'-,,.-.Depf� - ------- <br /> -Dis Number of pits V, <br /> Field';— Distance-from z-nea rest--well-ftk�------,Disfa-nce-iirom,-foundatiov-;,;,--j-----------'Distance,to nearest-lot-line_ <br /> Number of lines-------/-_.____f----------------Length- of each line------f�V---------------Width of french------—2-- _V—_ <br /> ----------------- <br /> Type of filter maferial..;T__4—��-_6—' Depth of-filter material___ <br /> Rem in and/or repairing (describe):------ ----- - -- ------- ------ <br /> ---------------------------------------------------------­----------------------------------------------------------------W-------------------------------------------------------------- ------- ------------ <br /> ---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------- <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 and regulations of the San Joaquin Local Health District. err <br /> (Signed),._J -,_ <br /> By:--------------------------t ------------------------------------------------------ -------------------------------------------------------------------- <br /> I------------(Owner and/or Contractor) <br /> ---------------- <br /> ---------------------------------------------------------------------------------------------------(Title)---- <br /> (Plot plans, showing size of[of, location of system in relation to wells, buildings, etc., <br /> must be filed with this aplp lication). <br /> FOR DEPARTMENT USE ONLY <br /> ---------- - <br /> ------------ <br /> APPLICATION ACCEPTED BY------------ --- - -------------- <br /> ----------------------------------------------- -------------- ------------ ---------------- ----------- <br /> REVIEWED BY------------------------------ D <br /> --------------------------------------------------------------- --------------------------------- DATE PERMIT ISSUED---------------------------------------------------------------------11------------------------------- DATE <br /> Alterationsand/or recommendations___________________________ —-------------------------------------------------- •--- -----------------------------------------------------------------------------------------------------------­------------------------------------ <br /> ----------------------------------------------------------------------------------------------—-------------17�----------------------------------------- ----------------------------------------------------------------------- <br /> ------------------------------------------------- *4 <br /> ------------ :----------------------------------------------------------- ---------------- <br /> ---- <br /> --------------- <br /> ------------------------------------ <br /> -------------------------------------------L-------------------­--------------------------------------- ---- --------- - -- -------------- <br /> PERMIT No------- / <br /> - --------- ISSUED------ .-----.(Date) FINAL INSPECTION BY____ ----- --------- <br /> -------------- <br /> • <br /> Date----- <br /> ..........----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> '.130 South American S+Peo+ <br /> Stockton, California <br /> rS--9-2M 9-50 W-1639 <br />