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`APPLICATION FOR SANITATION PERMIT <br /> .. (Complete in Duplicate) j <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 application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION -- f (a�7C': e cif.. -.---a'-��7..(�i^�3��r� <br /> «, <br /> c i'^owners —66 9& <br /> Name-- ---- - -- --- - ----- <br /> .... <br /> --,: Phone_ <br /> Addres ---- ------ -------- ------- --------- ------------ ----- -------- - <br /> ------------ --- <br /> ----- ----- <br /> ' Contractor's :Name------ I3�lta--------------- -- - <----- ---- -------- ----- ------- ------- -------- -- one ------------ -- <br /> Ph 3 395 <br /> Installation willserve :Residence ❑ omE]Apartment,House ❑ Cmercial Trailer Court D ` <br /> Motel E] Other ®afe <br /> - .��. �°i� s � - les <br /> Number of living units: E] Number of,be.drooms�❑. Number of baths [2� of size-___---__.-)5M.1--------------- <br /> Water Supply: -' Public system P9 ;Community system-'❑ Private E] <br /> Character of,soil to a depth of 3 feet: . Sand ❑ .a Gravel �] "Sandy Loam E] Clay Loam El Clay E] Adobes] Hardpan E] <br /> TYPE OF INSTALLATION AND SPECIF.ICATIONS Y. <br /> I'Mewer is,a <br /> 5e tIc Taokseptic t Dktancesf from nearest.,es�wellf publics Distancvailable within 200 feet.) <br /> T <br /> ------Distance from foundation--------1-O'-__-.Material--------- ? ;sj;-obi''s_ I_ ._.._. <br /> p No. of:com artments..- 2 r <br /> p - Capacity - g©� Size k4f x4 Liquid depth <br /> Distance from nearest well-----------------Distance from foundation--------------------Lining material----.----------------- ..._..---___. <br /> ❑ Size: Diameter----------------------••-=-------- ---Depth;--.-------.---.--------- ------------------------ <br /> Priv Distance from nearest well................... <br /> ' 'y; _---=--------------------Distance from nearest building--------_----------••----_--'- �F <br /> ❑ Distance to nearest lot line-_--_--_......................... <br /> Seepage Pit: . Distance to nearest well--------- Distance from{•�-,,foundation-------8'-... Distance to nearest lot Ilene_ ..-_ ----- <br /> [5� Number of pits-------�/ y . kMa Did,111 '$� ize: Diameter----- Q�.----- <br /> knin ma era Depth -------18 <br /> ' e____. .1 <br /> Disposal Field: Distance from nearest well-.....- Distance-from foundation-------5._.__---_Distance to nearest lot lin _..._._ <br /> Q Number of lines-... . " _ ' ngth of-each lire___3?3:a.3 O;t--------vY dthrof trench __2-1-- -__ . � <br /> Type of filter materia! Y'_p.0 _ ;,Depth 'of filter material,----18---------• <br /> ET { -- Inst2--t�.nk5 and avp. 30' of 1ea C' <br /> Remodeling and/or:repairing (describe):--------- :="_, Z -f-----r;--- - ---------------------------------------------------------- — ----- - <br /> a Lis--_ane-------I' t----__ ,12t ___ k?Q. �. F_._I,1? _,_�Q_-_2• .� r �l.i ._�1 G 'r, . _-71f---- S--�1�___� lta�________------------------ <br /> ------------ • Y <br /> ------------- <br /> ----- <br /> ------------------- <br /> f , <br /> -- ----- ---- ------------ - ------- -------- -- - = -- = - - <br /> hereby certify that l have prepared this apprcation"and thafahe work will be done in accordance with San Joaquin Coun I <br /> ordinances, State laws; and rules and' regulations,of'fhe'Sari Joaquin Local Health District. <br /> ............... -----=-------------------------------------------------------------------- (Owner and/or Contractor <br /> (Signed) <br /> By:----- w y :, -------------(Title)------ownex'--11S-r------------ ----------------- <br /> 1'_e— wartha:n--------------•- - - - <br /> (Plot plans, showing sae of lot-. location of.s�stem in relation to wells, buildings, etc., must be filed with this application). <br /> FOR-DEPARTMENT,USE ONLY <br /> APPLICATION ACCEPTED.BY---- '------------ ------ =--------------- ------ ------ ---- ----------------------------------------------- <br /> -------------- <br /> ------------------------ --------- <br /> ' .�' x - - , ------------- DATE------ - -- <br /> i REVIEWED BY------------------- ---------- = - - <br /> BUILDING PERMIT ISSUED----------- -= --------------------------------------- DATE lC <br /> . . :,Alterations and/or.recommendations:------ - -------------------------- --- °`----------•------------------ <br /> t <br /> -- <br /> .. .K' <br /> -------------------------------..------------- -----------_--------. .._-' --------------------- --------_------------._....---------........--------.......-----.--......-..----------------------- ----.. <br /> Q t <br /> PERMIT No.__�_ -.. <br /> ISSUED - •� J_---(Date) FINAL INSPECTION BY----------------------------------------------------------------- <br /> .. Date-------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES--9-2M 9-50 W-1639 --- � - <br />