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y, 06 �� APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate 0 <br /> CJ.S-- f7a--o6 i� 4 .\ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constru t and install the work h rein described. <br /> F <br /> This application is made in compkance_with County Ordinance No. 549. .�� <br /> JOB-ADDRESS AND LOCATION ----------R_f__;----------- X-----°$_ Al--Ml ---- ----- <br /> ---�9 <br /> Owner's Name------------------ Lft-q-Pra--------- '------- tlY:h ------ i -- -- -------- Phone--------_, _e0141 <br /> Address-, <br /> ------------------------------- ----------------�-1�^��------------- <br /> - ------------------------------------------- <br /> Contractor's Name,. Phone = --------_--------------- <br /> Installation will serve: Residence JZ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel <br /> ❑ Other ❑ <br /> Number of living units: -[] Number of bedrooms [2 Number of baths ❑ Lot -___ �_ -_. _ <br /> �'__r <br /> Water Supply: Public system F] Community system L] Private � _ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam. Clay Loam ❑ Clay ❑ 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_-_�--�0_---Distance fro fo ndation�-f�= ______.Material_______-_-- /v� _ <br /> a ` --- <br /> No. of compartments-------------- -�__Capacity.l�fundation <br /> _--Size------------__Y_5Y,3_Liquid depth-------��- <br /> Cesspool: Distance from nearest well-------- <br /> ---------Distance f ___-_-----------_--.Lining material-------------------------------------- <br /> 171 Size: Diameter-------_ -- Dept------------------- h------------------------- <br /> --- -------------------------- <br /> .Privy: Distance from nearest well--------------- -_----------------Distance from nearest building <br /> ❑ Distance to nearest lot line_______ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line----------------- <br /> ------------------------------ <br /> 0 Number of pits---------------`-___Lining material__-.._-_____-----------Size: Diameter_---_--__-___-_- <br /> Depth -----------------=------------ <br /> Disposal Field: Distance from nearest well_____-�-___-,-.Distance from foundation----__ _P_---_-_-Distance to nearest lot line_---�-..--- <br /> Number of lines----_____ _____� - y--__--.--Length of each line__/s_ CS �ef)Width of french-------P'Y-a <br /> r <br /> Type of filter material.---1-4--yo�6----Depth of filter materia------- <br /> Remodeling and/or repairing (describe): <br /> g p 9 ( --------------------------------•------------------------------------- <br /> --------------------------­-------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------ ----------------- <br /> ---------------- <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, an rules and regula • ns of the San Joaquin Local Health District. <br /> 00 <br /> (Signed)---------------=-`-- --------------------------------(Owner and/or Contractor) <br /> Sy:------------- Title i <br /> _ -------------------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- DATE <br /> REVIEWED BY DATE <br /> -------------- <br /> BUILDING PERMIT ISSUED ------------ ------------- DATE <br /> ------------------------------------ ------------------------ <br /> --------------------------------- <br /> Alterations and/or recommendations---------------------- <br /> --- --- <br /> _ <br /> -------------------------------------------------------------------------------------- -----__SS._, -i____---lY►_Ff "/l _-______-__ S___Q►-�__ o�.r� yl_ `-_- <br /> ---------------------------------------------------------•-------------------------------------------------- ---------------------= <br /> ----------------------------------------------•----------------------------------------------------------- <br /> W�r5------•;, -- 7C <br /> ------ : <br /> ---------------------- ------ <br /> F ,/_A- v -PERMIT N ------- ISSUED-__---- ---_-`�`----„ -- (Date) INAL INSPECTION BY--------------- <br /> Date--------------- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT "'� "J , <br /> 130 South American Street <br /> E5-9-2M 9-50 W=1639 Stockton, California <br />