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4 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 LOCATIO _----5 3- [ f --------IQf_ - <br /> Owner's Name = `' -�(-1 ......----- Phone 6 1� <br /> Address------------1-0-- Q ' -------� - /✓ <br /> Contractor's Name------------------64c4-_4-,*_ _t----------------------------------------------- --------------------- Phone------------------------------ <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel P Other [I <br /> Number of living units: Number of bedrooms Number of baths JE] Lot size---------- __r7f------ <br /> Wafer Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe p� Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: G1 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1 <br /> Septic Tank: Distance from nearest well---- -------- <br /> --____-Distance from--oundation_--__-/0__-___-Material <br /> -_-_--- ------------ <br /> No. <br /> ----------- <br /> No. of compartments--------��-- --Capacity-_-� �----Size--- Liquid depth------- <br /> �- ------ -- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining maferial------------------------------------- <br /> ElSize: Diameter--------------------------------------Depth--------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line________________________________________________ <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__t------__-_-Distance from foundation____---�-_v_-_Distance to nearest lot line.--_..,� <br /> Number of lines____________1y- -__ _ -_-Length of each line- 30 -)y_4 _�aWidth of french-------- -`-------__------ <br /> Type of filter material--/— __ epth of filter material___-----�e?_--___ <br /> Remodeling and/or repairing (describe):-------------- - w-----------i-/ j- 'E'-c> --------------------------------------------------------•---- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------• -- <br /> I hereby certify that §des <br /> prepa this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta ws and ulations of the San Joaquin Local Health District. <br /> ------ - ---------- ' . <br /> (Signed) ------- -------------------------------(Owner and/or Contractor) <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title <br /> ) <br /> - ------------------------------- <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----------------- -- ---- --- DATE-----_---- - <br /> REVIEWEDBY---------------------------------------------------------------- DATE--------------------------------------- ------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE <br /> Alterations and/or recommendations------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------- <br /> -----------------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------­-- ­•-------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> PERMIT No.__j-_?)_�------- ISSUED_-_-- _--_3__b____5---- _------(Date) FINAL INSPECTION BY:--------- -� -------------------------------- <br /> Date---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-21A 9.50 W=1639 <br />