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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 <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION----- ---------0-r-----41- ---------- ------------------------------------------------------ <br /> Owner's Name--c '4-JoR <br /> .!C - Phone------------------------------------ <br /> t c-1,1� <br /> Address------- ------------W! `------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name----lxt/C---- --------------------------------------------------- --- Phone-- '1- 0 <br /> Installation <br /> hone--- <br /> Installation will serve: Residence X Apartment House El Commercial F1 Trailer Court Ej Motel El Other 0 <br /> Number of living units: Number of bedrooms;2_ Number of baths t Lot size----__/--470--t-__-_1__Q-Q---------------------- <br /> Water Supply: Public system Community system F1 Private F-1 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [:] Sandy Loam E] Clay Loam [-] Clay 0 Adobe[] Hardpan I-] <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-----------------Distance from foundation------------------- -------------------------------------------------- <br /> No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> ElSize: Diameter--------------------------------------Depth---------------------------------------------------- <br /> .,Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_--------------_-__________-_------------- , <br /> ❑ <br /> uilding---------------------------------------- <br /> E-1 Distance to nearest lot line-------_--------------------------- - -- _ <br /> Seepage <br /> ine------------------------------------------------ <br /> Seepage Pit: Distance to nearest well----------—--------Distance fr9m foyridafion---JZ------Distanceso nearest lot lin ---- -- <br /> - ----- <br /> e- <br /> Number of pits-----------/--------Lining material---421-OW4Size: Diameter------0—?-"---Depth- ------ <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line__---_-__--___ <br /> `�' 't Number <br /> ine2,t---------------- <br /> Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material_________________________Depth of filter material_---_--- __--___-___ " <br /> -Remodeling <br /> aterial----------------------- <br /> 'Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------•------------------------------- ----------—---------------------------------------I--------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- ----------- <br /> ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- <br /> I here6y 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 Local Health District. <br /> (Signed)---Djt-A--�- -- <br /> -------------- -------------------------------------------------------------------[Gwnep-a"d/or Contractor) <br /> By:---- -------------------------------------------------------------------(Title)----cdZ4146 V----- ------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must 6e filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- —------------ ---------------------------------------- DATE-------- <br /> ------------2--- ----------------- <br /> REVIEWEDBY------------------------------------------------------------------------------------ --------------------------------------- DATE----------- -------------------------- ---------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------- <br /> ecommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------------------------------------------------------------------------------:------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - ------------------- -------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------- ----- -------- <br /> PERMIT ----- -V 7/-- --------(Date) FINAL INSPECTION BY: ------------------------------------- <br /> No.-6--jl� /---- ISSUED- <br /> Date-------------------- --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-S0 W-1639 <br />