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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 appliGation.is madein.compiiance with County Ordinance No. 549. 171— <br />JOB <br />71—JOB ADDRESS AND LOCATION --- R%_1►__.B=_ ,_..St0.ekton;..Hi-Way-..99--South,•-ate <br />Owner's Name ....... .._JQfi6:_ K----- Ewbb811• .................•-•-----•-•--•--•••----------......... ------------------•--•-------- Phone -------- --None_------ •.._. <br />Address-- -........................................ M ...e..._.-----•-•-•---•----•----•--------------•------------------------------•----- _ ----••---•---•----------•-•--------••-•--•---••-------------- <br />Contractor's Name----- --------•--•- -------- INS__.._. Phone ._.. 4-9607 -- ....a <br />Installation will serve: Residence [a' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />Number o7 living units: -91 Number of bedrooms Ej Number of baths [I Lot size ----- ---------•-_-...___________-__-_-_ <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 M' Hardpan ❑ , <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.] <br />t <br />'Septic Tank: Distance from nearest well.................Distance from foundation ____•.-...________-- Material ---------- _---_--___-_____-_--____--____..___�� <br />No. of compartments --------------------------- Caaci _- Size --------------------------- ._-_-Liquid depth. .......................... <br />Cesspool: Distance from nearest well.................Distance from foundarion -------------------- Lining material.. ............. <br />❑ Size: Diameter-----------_----------------- ... Depth -. ----------•-••------------------------- --------- <br />Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building .................. _ -------- ........ i <br />❑ Distance to nearest lot line____ _________________ --- <br />Seepage Pit: Distance to nearest well ........ IQ9t.. Distance from foundation ...... 30_ ....... Distance to nearest lot line ...... 310!---- <br />IIt- Number of pits ------3,------------- Lining material ------- fit_ G.. i r#k Diameter --- __-,33! ......... Depth ......... =!•-___...... <br />__-• <br />,isposal Field: Distance from nearest wall __-_.--_-_•__._.Distance from ._foundation .... _______________Distance to nearest lot line ............. <br />❑ 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):_ -••-----------s PP1gq";!tAM._M4 Q --------- .:-`------------------------------------------------------------ i <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 />ordinances, State laws, and rules and regulations of the_San Joaquin Logia! Health District. ! <br />(Signed P SR SOINSV IM-------------------------+--------------------------------------- Contractor) <br />(Plot plans, showin ize of lot, location of systAn in relation to wells, buildings, etc., must be filed with this application). <br />FOR DEPARTMENT USE ONLY <br />APPLICATIONACCEPTED BY---.----- -_ - _ -- •- .. -------_------------------------ DATE.... ... --_.....----------------------------------------- <br />DATE---/_-,...._ --� <br />REVIEWEDBY---------------- -------... _ . _ .. - -- -•-------�-..-- -- ------...------------ �----Y---•fir -----• ------------ <br />BUILDING <br />---- - ----BUILDING PERMIT ISSUED - _---------_ DATE - <br />Alterations and/or recommendations: ------------ - -.. ------------------- - ----------------------------------...---•----•-----------•-----•------------------------------•---- <br />•--------------•---------------------•--......._...---..._..----------------........... ................... --••............ ____ .......... --................. ----- <br />......----- •----------•------y <br />PERMIT No..:- --- ISSUED.... ............................ .... ....(Date) FINAL INSPECTION BY:---- -%----------------. -------- <br />Date----- ----------- -V"-z• -. <br />V . <br />E$ -9-2M 9-50 WI639 j <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street <br />Stockton, California <br />