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i <br /> APPLICATION FOR SANITATION PERMIT <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 /> JOB ADDRESS AND LOCATION__ _` _ _ I'/(/a;z`r�4l <br /> - ------------------------- <br /> ! ----------------------------------------------------------------------------------------- - - <br /> Owner's Name N �-'--------- <br /> --------------------------------------- Phone-----? 4-------- <br /> Address--------------- r Gl�'° <br /> ------------------------------------- q_ e----- <br /> ------------------------ <br /> Contractor's Name______ . <br /> --------- --- - Phone_---------------------------------- <br /> - - --------------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial x Trailer Court ❑ Motel <br /> ❑ Other ❑ <br /> lJoya,Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size----'YS-_-0 �C_ 406 <br /> Water Supply: ' Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand [IGravel ❑ Sandy Loam E] Clay Loam [:jClayK Adobe [Hardpan F1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' <br /> Septic Distance from nearest well--__"'r"---Distance from foundation_____ 0------Material-_____ -r-v <br /> No_ of compartments____________ _ <br /> `-------Capacity-____ ----Size__`_ x_$- --___---Liquid depth------- <br /> ---- --- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--- ---------------Lining material---------------------------------_ <br /> Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Distance <br /> -=-------------- <br /> -------------------------------- <br /> Distance from nearest well-------------------------- Distance from-------------- -- nearest building__--__.--___--__ <br /> Distance to nearest lot line_ � G . <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 /> Disposal Field: Distance from nearest well__ _____.Distance from foundation_ �U -- <br /> ---------- ------Distance to nearest lot line_-_`S- _---_ <br /> ❑ Number of fines-"----_____.-,-f________________Length of each line-___�Sd_ 3 s� Width of trench-____ !-_____---___ <br /> Type of filter material��"_�___De th of filter material-"--__-A?___----_ <br /> Remodeling and/or repairing (describje):_____-- - --_ <br /> --- --- ------ <br /> --------------------------- amt-�.,. <br /> -------- <br /> 4 ------------------------------------- <br /> --------------------- <br /> __________________________________ <br /> F <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --__--"----------------------•----_---"-_---__---___"----_---__"---_------__-_"--------___"---__-__-_---_-"----__---_-_--_-"---_---_-__-"--__------_-----_-_-____"-_----_----_-_--_-_------------------------------- <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. <br /> } <br /> Si nod) ---------- <br /> , - t <br /> t ( 9 )----- -•----.--- <br /> ,�- 13 (Ownerand/or Contractor) <br /> __�p------------------ - -------------(Title)-------------- n o tor) <br /> (Piot plans, showing size of lot, location o system in relation to well s, buildings, etc., must be filed with this application). <br /> y t --------------------------- <br /> ------------------------------------ <br /> --"---- <br /> r FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ --------------=-------- • �, a <br /> --------- DATE------- ------------- ------ ------------ <br /> REVIEWED BY K <br /> ------------------------------- -------------------------------------------------- DATE- <br /> BUILDING PERMIT ISSUED_____________________________ <br /> ----- ------------------- DATE <br /> fI <br /> ----------------------------------------------- <br /> Alterations and/or recommendations:-_I-_____________ <br /> ------------------------------ <br /> ----------------------------------------------- -- <br /> ---------------------------------- <br /> --------------------------------- <br /> -------------------------------•---•-- <br /> - -------------------------------------------- <br /> ------ -••------•---------------------------------------------------------------------- <br /> -•---------•----------------- <br /> PERMIT No.--/-T-5/----------- ISSUED---- �--'_�-•9--- 5 -------(Date) FINAL INSPECTION BY:--------------X11-- <br /> Date------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ES-9-2M 9-50 W-1639 Stockton, California <br />