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APPLICATION FOR SANITATION <br /> PERMITS <br /> (Com"p lefe in Duplicate <br /> Application is-Hereby made to the San Joaquin Local Health District for a permit to!construct and install the work herein describe <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> -L4 <br /> JOB ADDRESS:AND LOCATION----------A--------�/--------/2,-7-x ,!V- <br /> ------ <br /> Owner's Name-!`------ <br /> ,6-,o------ --------------- --------------------------------------- Phone ------- <br /> Address----------- -------- -----------------------------------------------------------I—------- ------------------------------------------------ <br /> Contractor's Name------------------- --------------------------------------------------------------------------------------------.-- Phone----------------------------------- <br /> Installation will 'serve Residence W Apartment House E] Commercial El Trailer Court El Motel E] Other E] <br /> Number?of living units: ] Number of bedrooms Q Nuimber of baths [Z] Lot. <br /> -- -- _________________ <br /> Wafer Supply: Public system E] 'Community system [] 'Private OU f <br /> X, <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [A Clay Loam ❑ Clay 0. Adobe Ej Hardpan Eklzl <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) GA- # <br /> Septic Tank-: Distance from 'nearest welI­-J-t/,-"-/-.t9is+ance from foundation--------------------Material---------(,&Vl-------------!F��------------- <br /> .. j/-1, -?-4/'--. _ I" , <br /> 6. -Size---------L:------------- <br /> II No. of compartments----------I-------------Ca pa city--'ik�. - _____Liquid depth______ <br /> arest well---;�� -bi�fance from Cesspool: Distance from nearest f fo ndation----- ------ ------Lining material____________________________ ----- <br /> Eln Size: Diameter--------------------------------------D e pf"h----------------------------------------------------- <br /> Privy: Dcstance from nearest well____________________----------------------------Disfance'from nearest building-------------------------------------------- <br /> El :1 Dis+ance to nearest lot line-----------------------__,_,-------------.__-- 1 <br /> 'Seepage <br /> ine--.-.------------------------ -------------- <br /> 'Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to ,nearest lot line________________ <br /> Number of pits-------•--------------Lining material-----------------------Sze: Diameter------------------------Depfk----------------------------------- <br /> Disposal -Field:41. Distance from-neares+ well----7- --- <br /> j '.Distance froffi-f6inclaflon-­ ------- Di�fa6co to nearest, <br /> ; 49 <br /> Number,of lines---------------- -----------Length of each,' -r-.'--.Widfb of ------- <br /> Type of-filfer material-------------------------Depth of filter material__________.:'_____ <br /> Remodeling and/or repairing (describe)-------------------------------------------------------------------------1�---- ------------------------------------------------------------------------- <br /> J <br /> -------------------------------------------------------------------------------------------------------------------------------------------------7---------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------L------------------------------------------------- <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 /> (Signed) ----------- <br /> ---------------------------------------(Owner and/or Contractor) <br /> By:-------- <br /> ----------------------------------------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, efc., must be filed with this application). <br /> .FOR DEPARTMENT, <br /> USE ONLY <br /> APPLICATION ACCEPTED BY­4-/P4�';_ ---------------------------------------------------------------------- DATE----`S---- 4k--4k2-�---------------------------- <br /> ---------- <br /> REVIEWED BY--------- <br /> ------ -----------------------­-------------- DATE------r- ------------------------------ <br /> ----------------------;----- ------------- ---------- <br /> BUILDING PERMIT ISSUED------------------------------------- ---------- DATE------------------------------------- <br /> ----------------- ------------------- ---- -------- <br /> Alterations and/or recommendations:-------------------------------------------------------------------------------------------- ----------------­----------------------------------I-------------- <br /> ------------------------------------- ------------------------------------------------...... ------ -- ------ <br /> ------------------- -------------- ­------------------------- <br /> 4,r <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------­---------------- ------------------- <br /> ----------- <br /> --------------------------------------------------- --------------- -------------------------------------- -------- ------------------ --- -------------------- <br /> 0 ­ ---------------- ------------- - <br /> -------------------------------------------------------------------------------------------------------------------------------- <br /> --- ------- <br /> VV 4t <br /> PERMIT INSPECTION -------- ---------------------------------------- <br /> No.J­-')-­------- ISSUED---;--,- J-1 (Date) FINAL INSPE& N BY� <br /> -------------- y <br /> Date---------------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 4-50 W=1639 <br />