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APPLICATION FOR SANITATION PERMIT <br /> �� <br /> (Complete in Duplicate) <br /> Application <br /> 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 /> ------------ <br /> JOB ADDRESS AND LOCATION--__.____ AM <br /> ------------ ------- --------- <br /> Owner's Name---------- 0 A <br /> 6�----All /V-------ZA-PD---------------- ------------------------------------------- Phone <br /> Address--------------------------- <br /> 2--------------------- <br /> Contractor's Name------------------------ A.......... ------------------ <br /> ------ Phone---'/ <br /> .Installation will serve: Residence Apartment House E] Commercial E] Trailer Court 0 Motel E] Other ❑ <br /> Number of living units: [Z Number of bedrooms Z Number of baths 14 Lot size--- K__/W5R7_10 <br /> Water Supply: Public system E] Community system El&'Private <br /> ,'Character of soil to a depth of 3 feet:1 Sand Ej Pravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe Hardpan ❑ <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--------------------Material <br /> No. of._cornp_arfmenfs--------------- Capacity-----------------------Size--------------------------------Liquid depth-------------------------- <br /> -Cesspool: Distance from nearest well_____ <br /> Distance from founclati on--------------------Lining material________._.________---___..______._;. <br /> 1771 Size: Diameter--------------------------------------Dept h---------------------------------I------------------ <br /> Privy: -Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> F1 Distance to nearest lot line <br /> 4.9 <br /> Distance to nearest a <br /> Seepage Pit: f we1J__ ------Distance from foundation__ Distance to nearest lot line--4 ------- <br /> 1 14---------- 1 " <br /> Number of pifs---Oft------Lining material-ZA&K------Size- Diameter-.13-­ Dept h-------Z ___________________ <br />-,,.D isposa I_-Fie Id: Distance-.from-nearest�e I I =------- unda.tion--------- D is fajjc.%fo q§g <br /> -m J� ciqsfjpf_Iine----------------- <br /> EI Number of lines----------------------------- ----Length of each line------------------------------Width of trench------------------------------------- <br /> Type of filter mate'rial-------------------------Depth of filter material----------------------- <br /> Remodeling and/or repairing (describe):_________ ZZ------- -------------------------------- <br /> ---------------- --------I--- ---------------------------- -------- ------ <br /> L------------- ------------- ----------------- - 1- ------- ----- ----------------- <br /> ------------ -- ---- --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ <br /> - -------------------4------��S_ ------------------------------------1, ----------------------------------------------------------------------------------------------------------------------------------- <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, Stat laws, and rules and_re%ilations of the San Joaquin Local Health District. <br /> ctor) <br /> (Signed) -- ---- ------ AOZ J__ <br /> a- zz <br /> By:---------------- ----------- - --- ------------------ <br /> syste. to wells, buildings, etc., m <br /> (Plot plans, showing she o to+, location m in relafio'?�� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------4-------- -- ----------- DATE <br /> REVIEWED BY-------------------------------------A� e—- ----- ---------- ---------------------------------- A <br /> ------------------- ----------- DATE <br /> ------------------------------------------------ iro _7------------ <br /> BUILDING PERMIT ISSUED--------z�� -------------------- DATE- ----------------------------- ---- - <br /> Alterations and/or recommendations:- ----- - <br /> -------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------------------------------L- ----------------------------------------------------------------------------------------------------------------------------- <br /> ------------------11------------------------------------------11-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------- <br /> PERMIT No/_&9_7�' ISSUED_________ -- (Date) FINAL INSPECTION BY: ---- ------I-------------------------------------- <br /> Date------- fF <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />