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APPLICATION FOR SANITATION PERMIT � �• <br /> /_..__� (Complete in 'Duplicate) <br /> f <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---------------32-0---Kho;r1G2r-;r-a;l_j----------------------------------------------- <br /> Owner's Name-- -------Ad __-�he5''nE'._�-- -------=-- - ----------------------------------------- <br /> ------ Phone--------- i-08-2-0L--------- <br /> Address_. ©._ > Q Z4'D `� ' - --------------------------------------------------------------------------- <br /> Phone -'}a3} <br /> Contractor's Name-------- 2- .a----------------------------------- - <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ElTrailer :Court E] Motel ❑ Other E] <br /> Lot size--- --------------------- <br />:� Number of living units: '[J. Number of bedrooms � Number of baths [I �-4���-----•---�--------- <br /> Water Supply: Public system 91 Community system ❑ Private ❑ , <br /> f' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ SandyLoam [IClay Loam ❑ Clay E] Adobe❑g Hardpan ❑ <br /> 4 <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 /> EXiSgTI3G No. of compartments--------------------- -- <br /> -Capacity-----------------------Size--------------------------------Liquid depth-------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining materia------------------------------------- <br /> Sze: Diameter-------------_-- - - - <br /> ---------Depth---------------------------------------------------- <br /> ❑ irest well___.__. <br /> � .. •----, ,. <br /> .Privy:- Distance from nea ______'. <br /> --------------Distance from nearest building------------------"----------------------- <br /> --_- <br /> ❑ Distance to nearest lot line ._____�____.______---------------- ------ <br /> - --- <br /> Seepage Pit: Distance to nearest well-.--.�Q______--Distance fro m`faunda'ion___._ __-- '" Distance t-- nearest loft line--__-__.-._.._ <br /> Lining material---br-1.Ck----.Size: Diameter---�-------------Depth--------- !-------------- <br /> ® Number of pifs-----1-------------- " <br /> Disposal Field: Distance from nearest well----____- ---Distance from foundation__ Qistance to nearest lot line_________________ <br /> "EXIUING Number of lines-----------------------------------Length of each line-----------------------------"Width of trench_:-_-.----------------- , <br /> Type of,filter material-------------------------Depth of filter material--------.-------------- <br /> Remodeling and/or repairing (describe):------------- 1>? n- &v;.--'mar-tdraj--&r --oinly---an—d--- ahn <br /> u.10---t�---the---�x-istinS---sem ti.a --t-9.nk_-writh---so-l'-d---7-ine- ----- ------------ ------- <br /> ---------------------- ---- <br /> ------- ---- ----------------------------------------------------------------- <br /> hereby certify that I have-prepared this application and that +he 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 /> caner and/orC act <br /> (Signed) DRlt-E.-- ---------------- --- ------------------------ <br /> ---------- <br /> (Plot plans, showing size of lot, location of system in el o to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> kAPPLICATION ACCEPTED BY_. ---- ------------------------------------- DATE ------------------------------------------------- <br /> REVIEWEDBY-------------- --==------------ — ---- - ------------------------- DATE ' <br /> ¢ BUILDING PERMIT ISSUED-----..--- DATE <br /> Ei -------------------------------- ------•-------------------------------- <br /> Alterations and/or recommendations------------------------------- ---------------------------------------------' <br /> ------------------------------ <br /> 1. ----------------------------- <br /> ----------------------------------------------------------------------------- <br /> -------------------- <br /> --------------------------i <br /> --------------------------------- <br /> �/ /�t- Date FINAL INSPECTION BY.PERMIT No�'�"- : ----- ------ ----------------------------- -------------- - <br /> - - ISSUED---- -------- - <br /> ------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-:-2M 9-50 W=1639 <br />