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APPLICATION FOR PERMIT SANITATION P 717 ' <br /> (Complete in Duplicat_e) <br /> Application is hereby madJo 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. 49. <br /> 1 � <br /> Cab ADDRESS A D LOCATION-__ --- _ �-_ <br /> } <br /> Owner's Name .--•-------------- ?-----•- �- � 1 . <br /> - ----------------- ------- <br /> --------- Phone- - V_ <br /> Address -•----- <br /> ------- <br /> Contractor's Name---- ------- ----- - <br /> _ ---- - --------- --------------•----- Phone <br /> Installation will serve: Residence Apartment House ❑ ;Commercial <br /> � ❑ -Trailer Court ❑ Mot I ❑ Other ❑ a <br /> Number of livingunits: umber of bedrooms r <br /> � ��Number of baths [� Lot `size____!_- -�_ <br /> Water Supply: Public system Community system ❑ Private, <br /> El <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy'Loam ❑ lay Loam ❑ Clay F Adobe Hardpan ❑ <br /> tk <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No septic Tank or cesspool permifted'if public sewer is available within 200 feet.} <br /> Septic ank: Distance from nearest well________________Distance from f u dation___ / 0 .Materi s .- � <br /> - ------------- --- ------- <br /> ��yy r <br /> No. of compartmen#s-----------/`�_______--Capacity---- ----Size_��., ---�4± X�igw depth----•----- ---------------- <br /> Ce -------- . <br /> sspool: Distance from nearest wefl________________Distance from found ation____________________Lining material_______________-______-___--_____- <br /> ❑ Size: Diameter______________________ <br /> --------- -----Depth-----'--------------------------------------------- <br /> Privy: Distance from nearest well__________________ � __ Distance from nearest buildin <br /> • g------------------------------------------ <br /> ❑ Distance to nearest lot line_______ __________ <br /> ` [ <br /> I Seepage Pit: Distance to nearest well <br /> El <br /> from foundation_-_________________.Distance to.nearest lot _______--______-_ <br /> ❑ R Number of pits----------------------Lining material-._--------------------Size: Diameter----------------------•,Depth______ <br /> Dispos�� Field: Distance from nearest w II___ ____________Distance from foundation <br /> Distance to nearest I dine__-4745------- <br /> Number of lines___-- _____________Length of each line____ -io-- <br /> Type _ Width of tren _ <br /> ` of filter materi t ------------------- <br /> T "'I"aDepth of filter material____-_____ ____-_,•-- <br /> } Remodeling and/or repairing (describe):_______________________ <br /> -----------------•------- <br /> --------------------------------------------------------- <br /> ------------•---------------- <br /> ---------------------------------- <br /> e ---•-- -----------------------------------------------------------------------------•-------------------•---------------- <br /> her cery that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta e ws, and rules a d regulations of the S JBaquin'Local Health District. <br /> (Signed).s=_' ----- <br /> - --------- <br /> f. ---- -----------------------------------------------------------------(Owner an /or Contract r <br /> (Br----------------------------------------- - °---------------•--------------------------- -------------- --- -------------------(rtle} --------------------------------.- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- tJ t <br /> -- -------------------------------------------------------- DATE----- - ---- -- <br /> REVIEWED BY <br /> - - -- -- °^ <br /> ---- ------------------------------- l0 J- - <br /> BUILDING PERMIT 1SSUED---------------------------------- - --------- ---------- ------ DATE---------7--------------- <br /> ----------------------- --------------- DATE <br /> -------------------------- <br /> Alterations and/or recommendations________________ <br /> ----------------------------------------------------------------7 --------------------------------------------------------------------------•------------ ------•---•-------------�--------------------------- <br /> PERMIT No-7-47-7.---- ISSU ___ <br /> ED_ __ __.�z/��---_---(Date] FINAL INSPECTION BY <br /> -- - ------------------------ <br /> ------------ <br /> { Date <br /> ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> E5---9-2M 9-50 W:1639 Stockton, California <br />