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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) � 0 <br /> Application is hereby made to the San Joaquin-'Locaf 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 LOC TIOL4___,�?_J_ / -Y _f-_---- ----j`a_ --------. 7_-- bl------------------------------------------ <br /> /►f'ar �.. '"" <br /> - <br /> Owner's Name-------------- --f- ---•f------ ----------- - - Phone------------------------------------- <br /> Address--------------------------------------- <br /> Contractor's Name--------------------'------------------------------------------------------------------------I----------------------------------------------- Phone------------------------------------ <br /> .Installation rwill serve: Residence Z Apartment House [] C\01ylmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ { <br /> Number of.living units: Number of bedrooms J❑ Number of baths �Z Lot size_____ d__- "� C� <br /> Water Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan�j <br /> ,4_je_ <br /> a <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �2 f <br /> Septic Tank: Distance from nearest well_ __Distance from foundation----/Q---------Material____! 4.v <br /> I No. of compartmentsCapacity-----��-- Size_- '- (--`fir -----Liquid depth tom.,-_---.--- - <br /> �______ b <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-------------------------------------- <br /> Size: <br /> ________----------_-_______-_-___ __. <br /> ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------=- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> F-1 <br /> � <br /> Distance to nearest lot line------------------------------------------------ <br /> Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line_________________ <br /> ❑ Number of;pits______________________Lining material______________ '� <br /> -------.Size: Diameter------------------------.Depth- --------------------- <br /> Disposal Field: Distance from nearest well_____ ________Distance from foundation___ Distance to nearest lot line_ __. <br /> gJ Number of lines_____________A- -_4__Dep+h <br /> Length of each ]ine__ ��_ -__Width of french-------- __�________-- <br /> ' <br /> Type of filter material_- :_ of filter material_____ __ _--`' ' <br /> Remodeling and/or repairing .(describe)------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> a <br /> ---------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- <br /> I hereby certify that .leave prepared this licallion and that the work will be done in accordance with San Joaquin County <br /> ordinances; State law , and "1 d gula+i of the San Joaquin Local Health District. <br /> (Signed)-_, <br /> ___________________(Owner and/or Contractor) <br /> By:-------------------------------------------------------------- ----------------------------------------------------------------- Tale <br /> (plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> i <br /> r FOR DEPARTM T USE ONLY <br /> APPLICATION ACCEPTED BY_______ _ � ___ ___,____ _ __ _ _ <br /> ¢ `' DATE _ <br /> `� <br /> REVIEWED BY <br /> BUILDING PERMIT 155UED-----*------------------------------ ------------ ----- -------------------------- - --------- DATE----- ---- ------------------•-------------------------- f <br /> 4 + <br /> --------------------------------------------------- DATE--------------------------- ---------------- - ---------- <br /> Alterations and/or recommendations•--------------------------------------•------------------------------------------------ <br /> --- ------------------------ --------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------:-------------------------------------------------------------------------------•-------------------------------------------------- <br /> ------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------•------------------- <br /> e <br /> ---------------------------------------------------------— <br /> -- -------------- ---- ----- <br /> PERMIT Noa o___�__5_ ISSUED___________ __ __ 1 __-----(Date) FINAL INSPECTION BY:_________--__ _ ______ <br /> Date------------ <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> + 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 ' <br />