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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 /> pP my Ordinance No. 549. <br /> This application is made in compliance with County . � E. Main ,5�. St�Ci!£tIIil <br /> JOBADDRESS AND LOCATION_- l--------L4YS--T .--- ASHD --------------------------------------------------------•------------------------------------------------ <br /> Owner s Name....Is-QY-S---�-•----�a.5_--min------------------- ------------- --------------------------------- <br /> Phone------3-111 b------------ <br /> ------------------------------ <br /> Address------ Q22__So� Anteros Street. Stockton ----------------------------------------------------------------------------------- <br /> f A 8897 -- <br /> Contractor's Name__ ---------------•--------------- Phone <br /> -`---�..----�'��-�-��h--�-_Sons-s---Inc*-------------e -------------�- <br /> Installation will serve: Residence E] Apartment House t& Commercial ❑Number ai eTr Court El Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms Iof baths Lot size____�_��----1f 0-------------------------------- <br /> r <br /> Water Supply: Public system ❑ Community system El Private `` <br /> Character of soil to.a depth of 3 feet: Sand El Gravel ❑ Sandy Loam El Clay Loam F1 Clay ❑ Adobe Hardpan ElW <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: .I <br /> (No septic tank or cesspool'permit+ed if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material---------------------------.-__________________- <br /> No. of compartments-------------------------Capacity-----------------------Size----------------•---------------Liquid depth-------------------------- <br /> Cesspool. Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> a Size: Diameter------------------------= Depth. <br /> t Privy: hDistance from nearest well-------------------------------------------------Distance from nearest building_____________________ <br /> Distance to,nearest lot line--,_________________________________________ <br /> s, Seepage Pit: Distance to nearest well_'_______________Distance from f undation--- _ Distance to nearest lot line__:3�______-_.., <br /> Number of pits________..I__________Lining rr aterial_.2tLR _____Size: Diameter____ i _____________Depth,�V � � <br /> '- Distance-to nearest lot-line--__________----- <br /> Disposal Field:,- Distance from�nearest�well=_"" __-_-:Distancef oundation___:_-____ <br /> Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material------------------------- of filter material------------------- <br /> S41 ?lu <br /> e '" <br /> Remodeling <br /> anandd/or epairing (de c ibe):____--- �' '�ti "�—'1 <br /> ---------------------------------------------------V--- --------------------------------- ------------------­----------------- ­-----------------------­---I----------------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 Local Health District. <br /> A, PIiRRIs &""SONS IIIc_.----- '---------------------t---------------------------------------------(� Contract <br /> (Signed)__ - or) <br /> -- --- -- ----- -------- -- -------(Title)_Es imat or---------------------------------- <br /> (7 4 <br /> Plot <br /> r <br /> (Plot pla howing size of lot, locatio of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICAT�10��N� ACC�EPTED BY = ----- ---------------------------------------------- DATE �� 1 yREV]EWEB = DATE-_---- �0- Via' --------------------------- <br /> BUILDINGPERMIT ISSUED------------------------ -------------------------------------------------------------------------------- DATE--------------•------------------------------------- <br /> Alterations and/or recommendations:----••--•------- ----------------------------------------------------------- --------------------•------------------------------------------------ <br /> A --------------------------------------------------------------------"---------- <br /> ______________________________________________________________________________`___-________-_... <br /> PERMIT No-------- -------- ISSUED ------------(Date) FINAL INSPECTION BY_-------------- - <br /> Date------------------- U-- ---- ----- ---- -`a------------------•--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICTr- <br /> 130 South American Street <br /> Stockton, California <br /> E$-9-2M 9-50 W-1639 <br /> r <br />