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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Appli'cation 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 OrdinanceNo. 549. <br /> 08 ADDRESS-AND LOCATION ---------- ---Rd------------------------------­--------------------------------------- <br /> _.J _a007---Iaw_e_r___3aar9�aenta <br /> 44' <br /> Owner's Name =:--------- <br /> ' ----------------- - -------------------4 t - ----- Phone - 4--- 9- <br /> --, - ­ ------------- <br /> &CC7--1nP --------------------------Address--_,------------ 3 - ----------------------------------------------0---1--4---------------------------- <br /> - <br /> Contractor's Name------------------D-e-3-ta--------------------------------------------------=--------------- ---------------------------------------- Phone-----'_"'3955----------- <br /> Installation <br /> ln3955------------- <br /> Installation will serve: Residence a� Apartment House E] Commercial 0 Trailer Court D Motel 0 Other El <br /> I 15. <br /> Number of living units: ❑ Number of"bedrooms M Number of baths EL Lot' size-----3/ }-_gore-_________________________________ <br /> - <br /> Water Supply: . Public system El Community system El Private E3, <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ 6by Loam ❑ Clay ❑ Adobe g] Hardpan <br /> A <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or-cesspool Permitted if public sewer is available within 200 feet.) <br /> Septic.Tank; Distance from nearest well----PO------Distance from foundation------5-- --.Material------?----------------------------------------- <br /> exE$ting No. of compartments-----------Z---------_-Ca acit --Size--------------------------------Li uid depth--------------------------- <br /> Cesspool: •-..Distance from nearest well------------------Disfance from rfoundation------------------- Lining material_____________________________-_____. <br /> r ' F Size: <br /> aterial-------------------------------------- <br /> Size: Diameter------ <br /> -------------------------------Pepfh---------------------------------------------------- <br /> Privy: Distance from nearest well----------------------------------- Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line----------------I------------------------11------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------.Distance.to nearest lot line_-_____--_______ <br /> ❑ Number <br /> ine----------------- <br /> Number of,pits--------------------- Lining rriaterial-----------!'�'-------------Size: Diameter------------------------Depth--------------------------------- <br /> LDisposal Field: Distance from nearest well-____15 from foundation_----5_"----------Distance to nearest lot line----5----------- <br /> t.1i- - of french---.18"---------------------- <br /> Number of lines--------3------------------- Ce�gfh' of each line---50.........-----------Width <br /> Type of filter material-Irook---------Depth of filter material--.--18............ <br /> —Remodeling and/or rep'air'ing (describe)-------------re--pairIng---------------------------------------------------------------------------------------------------------- <br /> -------------------------------- ----------------------------------m------------------ ----------------------------------------------------------------�!------------------------------------------------------------ <br /> ----------- <br /> ---------------------------- <br /> ----------------------- ------------ --------------------- ----------- -------!�16 _J------------------------­--------im-----------I-------- ------ -------- <br /> .Wm: ,. -11---It --- <br /> -------11-1------------- t <br /> hereby certify th'at 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 Joiiquin Local Health District. <br /> (Signed)------------------------ I---------- -------------------------------------------------------(Owner and/or Contractor) <br /> By------------Parr Y...TdartbAn------------- ------ -------------------------------------------------------(Title)-------Q_Wner_TTX9r'---_------------------------ <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be riled with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___________________ <br /> - DATE__________ __ - ------------------- <br /> --- <br /> REVIEWED BY---------I------------------------------------- - -------------- e-- -------- ------- ----------------------------- DATE---------- -----------/Jl/--------------------------- <br /> A <br /> BUILDINGPERMIT ISSUED-------------------- -------------------------------------------------------------- ----------------- DATE------------------------------------------------------- <br /> LAIteration's and/or recommendations:-------------------------------------------------------------------------------------------- -------------------------------­------------------------------- <br /> -- <br /> ------ <br /> ----------------------------------------------------------------------------------------------------------- --------- ------------------------------------------4------------------------------------------- <br /> ---------------------------------------------r-----------------------I------------------------------------------------------------------------------------- ---------­---------------------------------------------------- <br /> --------------------------- --------------------------- ----------------------------------------------------------------------------------------------------------------I------------------------------------------ <br /> ----------------------------------------------------------------------------------------------- ------------------ ----------------1-------------------------------------------------------------------------------------- <br /> 604 PERMIT -------- ISSUED---- --------------------.(Date) FINAL INSPECTION BY:-------N.- -------------------------­­--------- <br /> Date------------------- <br /> --------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9, 2M 11-50 W=1639 <br />