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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> •tel <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------- <br /> -------------------------------------------------------- <br /> Owner's Name----•---- mIg�:4--------4-A-;� �- ------- -- ---------- ---------- ------------------- - <br /> -----•------------ Phone <br /> --------------------------------------------- ----- —"--- ---- <br /> Address 'J -i-' ' ---=--------------------------------- - <br /> Contractor's Name..... .t. ! + <br /> ---- Phone---�: <br /> Installation will serve: Residence Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other El <br /> Number of living units: T Number of bedrooms' a Number of baths U] Lot size--------ilo_0_-------y---f7-4------------- <br /> Water <br /> 7----------------Water Supply: Public system] Community system ❑ 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 /> D------Material------- ------ ; r ------ <br /> Septic Tank: Distance from nearest well__����._.Distance from foundation_____._I <br /> No. of compartments--------r------I---Capacity + .----Size--- 'r �� ----------Liquid depth--------Al-------------- <br /> Cesspool: Distance from nearest well_____--________-Distance from foundation--------------------Lining materia--------- _________-__ <br /> ---- <br /> Size: Diameter--------------------------------------Depth--------------------- ---------------------------- <br /> 1 ❑ I Distance from nearest building-------------------------------------,�: <br /> .Privy: E Distance from nearest well_________________________ <br /> Distance to nearest lot line------------------------------------------------ <br /> t i Pit: Distance from foundation______t_I__________.Distance to nearest lot line_____ <br /> See❑a a Pit. Distance to nearest well____------- _ Depth_____________________ <br /> ------------ <br /> p <br /> Number of pits--------------------•-Lining material____________________---Size: Diameter----.---------_----- - . <br /> Disposal Field: Distance from nearest weII--.ems -AJ IJV V--Distance from foundation------II______'_Distance to nearest lot line_______/Q-�__ <br /> X71 i Number of lines----------- -r--------------Length of each line----- � ,yf' <br /> --- -- ---:-Width of french----------- <br /> �-»-+----------- <br /> Type of filter material-_-/`/2-'arf!!�k Depth of filter materiai______1e�._-_____ , <br /> h <br /> Remodeling and/or repairing (describe):. 11s� '_7�f -- ------ �- tl f`_I -_! 1V -N-- <br /> e 4 g--------------------------------------------------- <br /> :; . <br /> �- ------------------.-------- <br /> w <br /> -- <br /> A <br /> -!-------- --------- -------- - ----- - ---------- -------- - :_ <br /> Ihereby certify that I have prepared this application and fihat +he work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. <br /> I <br /> --Owner nd/or Contractor <br /> (Signed) <br /> -�--- -------=-- <br /> a`�y�"� (Title) f �: <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be file 'with this applica+ion . <br /> ='rte <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- <br /> -y! ---- ------ - <br /> ------------ ----- <br /> - ---------------------------- <br /> DATE------------1------ � f--------------------- <br /> REVlEWED BY - . DATE <br /> BUILI?!NG PERMIT ISSUED DATE <br /> +ions and/or recommendations:-------------------- <br /> ----------------- <br /> --------------- -------------------------------- -. <br /> Altera -------------------- ----- <br /> F---------------- ' ' f - - <br /> !i -------------------------- <br /> ------------------------------------------------------------ ------------------- <br /> 1 = _ ! <br /> --------------------- - �, r-�.t r if'. w <br /> ---------•-------------- <br /> , `; ----------------------------------------- ;1 �,, � -t c S h4 <br /> �f <br /> PERM ., A <br /> IT No.A-s-/ ----� f ------------------ <br /> ISSUED--- - - --J Date FINAL INSPECTION BY------------------------------ <br /> Date------------- ----------- --------------- <br /> ------------------- <br /> SAN JOA UIN LOCAL HEALTH DISTRICT I <br /> 130 South American Street <br /> 1 Stockton California <br /> ES-91 2M 9-50 W=1639 - <br /> l <br />