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Qv (0l <br /> 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 application is made in compliance with County Ord' nce No. 49. <br /> JOB ADDRESS AND LOCATION____ __ _ �...: e - <br /> ,, <br /> .. ----------------- <br /> Owner's Name----------Ralph-_)�SG__ r�1�,__ ----- ------- -- - Phone---3--8217- _----------- <br /> - ------------------------------------------ - <br /> Address-•------------------_2415+_l,st---Park---St-, ---------------------- -, <br /> " Contractor's Name___Sf'-------- <br /> -_-_•-------------- - �'�v . <br /> ------------------------- -----------------V-------- ------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence � Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other ❑ <br /> Number of living units: ❑ Number of bedrooms U Number of baths [ Lot size____-8IIX162---------------------------------------- <br /> Water Supply: Public system ❑ Community system E5k- Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑\ . <br /> x <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> 3 W <br /> Septic Tank: Distance from nearest well5Q---ft.Distance from foundat'onl0___f .__.Material_R£L�g1��C�-- ----------------____- , <br /> ® No. of compartments------2--------------- -capacity---800w,-g-a ize_3-�X �-----------------Liquid depth _ft <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------- <br /> ------------------*------------ € <br /> E ❑ Size: Diameter--------- ----------------------------Depth------------------------------------------------- <br /> - - I <br /> 6 . <br /> Privy: Distance from nearest well------------------------------------------------- __-___________Distance from nearest building <br /> ❑ Distance to nearest lot line-------------------------------------------- -- <br /> E Seepage Pit: Distance to nearest well------------------ :-Distance from foundation-------------------Distance to nearest lot line_____---�__------ <br /> ❑ Number of pits----------------:-----Lining material_-------------:--------Size: Diameter-----------------------.Depth--------------------------------- <br /> S :.Disposal Field: Distance from nearest wef150-__f—t Distance from foundation 0___f e7__Distance oto`nearest -1 __'57 <br /> ® Number of lines_____________ '" ength of`each line_ � � 3 'Width-of-trench_-Zf_r ,__-______------_-_ <br /> a f t <br /> Type of filter material___ ��f�<epth of filter material__/8_---- <br /> -Remodeling and/or repairing (describe)________________________________________ _ t't. <br /> -------------------- <br /> ------------------------------------------------------:-------- <br /> --------------------------- <br /> -------------------------------------------- <br /> -----------------------I <br /> ------------------------- <br /> - ------------------------------ --------------•-------------••--------•-------- <br /> 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 nd-rulesulations of the San Joaquin Local Health Districf. <br /> (Signed). "-- --- -------- -- ---------------------------- __ --------------------(Owner and/or Contractor). <br /> Plot lans, showing size of lot, location of system in relation to wells, build <br /> By: ----- ------(Title)----------------- -------------------------------------------- <br /> ( P g � Y ings,.etc.,'rriusf be filed with this application). <br /> rW` FOR'DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------� =1]l�=I : _ DATE <br /> REVIEWEDBY --- 1--244 ­----------------------------------------------------------- ------------ DATE------ <br />,. BUILDING PERMIT ISSUED-----------•--------•------------------------------------ ------=------------------------------------- DATE-------------- <br /> Alterations and/or recommendations______________________ <br /> --•------------------------------------------------•---------------------------------------------•----------------------------------------------- <br /> ------------------------ ----------------------------------- ----- -----------------------------------------------------•---------------------------- <br /> ------------------------------------------------------------------ ------------------------------------------------- -------------------------------------- <br /> PERMIT No.--/U_I------------- ISSUED-----!t_=_ - w? -__-------._ Date FINAL INSPECTION $Y:___.____-- <br /> [ 1 �__: �: _ _¢ ------------------ <br /> Date-----------------i a <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> fS—�4--2M 9-50 W=S634 — <br />