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- �ld <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 compliances with County Ordinance No.. 549. <br /> JOBADDRESS AND LOCATION-------------------------- Z_/---------------------------------------------------------------------------------------------- <br /> Owner's <br /> _/--------------------------------------------------------------------------------------------- <br /> Owner's Name----Nqo---n'J-a-ki-�a------��1_ .d--'---- r+"------------------------------------------------------------- Phone-- - 1 � <br /> Address-------. <br /> OMP 02 <br /> Contractor`s Name---- -lJ_ � Phone__P'"_50_ 97- <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms Number of baths 0 Lot size____j +p_.K---/_.2,`_1____ ______________________(� <br /> Water Supply: Public system Community system ❑ Private ❑ V� <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> [No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i <br /> Septic Tank: Distance from nearest well_________________Distance from foundation------ ;_-.Material___-C.__ ?_______. <br /> No. of compartments_______r�------------Capacity__"04 _Size-4_a �_,3Y__;i Liquid depth__________________ <br /> Cesspool: Distance from nearest well------------------Distance from foundation_-- -- __.Lining material-------------------------------------- <br /> R Size: Diameter--------------------------------------Depth---------------------------- <br /> ----------------------- <br /> Privy: Distance from nearest well-_____________________________ ------_____Distance from nearest building----------------------------------------- <br /> Distance <br /> ______._-______________---_____ ______- <br /> Distance to nearest lot line------------------------------------------------ <br /> Seepage <br /> __________________________________________Seepage Pit: Distance to nearest well--------_-------------Distance from fun da tion__________-Distance to nearest lot line---- <br /> Number of pits---------- -------._Lining material_d__ .__Size: Diameter---S3-_` <br /> -------.Depth____ 0__'_____ <br /> ---r-y------- <br /> Disposal Field: Distance from nearest well------------------Distance from foundation------/ ___.Distance to nearest lot line-------/__E._ <br /> Number of lines-------------I------------`` Length of each line-------� - -----------.Width of french------Y------------------- <br /> Type of filter material_�X___A�+!____ Depth of filter material------ja'4- w,..d6-,� <br /> Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------- -------------- <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 /> ordinancesWad and' regulatio of the San Joaquin Local Health District. <br /> tSi ned[ 9 ]..- ----- ------ �---------G- -`"�----------------------------------------- [ /or Contractor) <br /> By:- - - ----------------------------------------- ------------------------[Title) <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--------- ---------=--/ --- ?-Ocr�I---J------------------------- -------------- DATE------------------------P / ``"t� <br /> REVIEWED BY----------------------------------------- :en----- -- ----------------------- DATE � ---ai7 <br /> ----------------- - --------------------- 7 - ---ai7----------- <br /> ---------------PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE <br /> Alterations and/or recommendations---------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------•-I--------------------------------------------------------------------------------------------•---------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ­--------------------- ----------------------------------------------------------------------------------------I--- <br /> PERMIT No.______7_Y------- ISSUED___ 6_'s`_47-----------(Date) FINAL INSPECTION BY:-------LL__ <br /> --------------- <br /> Date---------------� - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2tvl' 9-50 W=1639 <br />