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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the SaniJoaquin 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 /> ee�� ---------7--- <br /> - ------------------------------------------------------------------------- <br /> JOB ADDRESS A LOCATION____..G�. /--_____ � - � <br /> Owner's Name. �= $ ® may//fir /' &- phone <br /> Address---------2, - --T-`--6-------- �- - ------------ ----------------------------------------- ------------ ----------------�------ <br /> Contractor's Name___ <br /> Phone - �' -1-- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court Motel El Other <br /> Number of living units: '❑ Number of bedrooms ❑ Number of baths ❑ Lot size-------------------------------------------------------------- <br /> Water Supply: Public systemCommunity system ElPrivate E] ` <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ a�! <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r �" <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 /> El <br /> _____________- ______________._----.❑ No. of compartments--------------------------Capacity-------- -- --- Size--------------------------------Liquid depth---------- ------------- I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------_--------"-_--_____. <br /> ❑ Size: Diameter------------------------------------Depth------------------- ----------------------------- <br /> Privy: Distance from nearest well________________-----------------------------------Distance from nearest building------------------------------------------ <br /> Distance to nearest lot line------------------------------------------- + <br /> Seepage _Pit: Distance to nearest WO--------------------- from foundation---------------,---_Distance to nearest lot line----------------- <br /> ❑ Number of pits---'---------------Lining material------------------------Size: Diameter------------------------Depth--------------------------------- <br /> Disposal Field: Distance from nearrest well___ ---.Distance from foundation_____Aa-e.--Distance to nearest lot line------ <br /> Type uber of lines_of filter material___ ,__ __ Length of each line__- y' <br /> f �. - _ f------Width of trench_PJ--____- <br /> Depth of filter mapterriiall_-_,.�_Z __---._- <br /> -Remodeling and/or repairing (describe)------------ "1 �-�-'� ----------------------------- <br /> 6 <br /> ""--"""""-------' <br /> 6------------ ----- ------------------------------------------- <br /> 4 <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 /> s , '--------------------------------------------------- <br /> --------------[ ne a or Contractor] <br /> (Signed)__D__,/+'Y�- <br /> -��'f - <br /> B -- - --- .ext ----- ---------------—------------------------------(Title)--- ------------------------- <br /> (Plot plans, showing size of lot, location of system +in relati--n ito'wells, buildings, etc., must be filed with this application). <br /> i <br /> ` FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---_--_-:`------------------ --- - ---------------------------------------------- DATE <br /> REVIEWED BY---------------------------------------- <br /> -------------V '------------------------------------------- - ------------- DA ------------------------------------------------------------ <br /> BUILDING <br /> ---------------- <br /> BUILDINGPERMIT ISSUED------------------------ ---- --------- - ---------- DATE------------ ----------------------------------------------- <br /> Alterations and/or recommendations:--------------------------------- ---------------------------------------------------------------------------------------------------------------------------- <br /> ---- ------------------------------------ f <br /> t ------------------------------------- , <br /> 1 -_-----_ Date FINAL,�1fNSPE-CTION BY:_------ -_ 7 -------------- <br /> PERMIT Na. -------- ISSUED_ g - —----- ) : ._ �. <br /> i Date- <br /> _ ------ <br /> r .�:-. <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT' +' <br /> 130 South American'Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 _ — <br />