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APPLICATION FOR SANITATION PERMIT <br /> I ,# � , <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 Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIQN--------3Z 1-1-- FA Kynoo- ------------------------- - -=-: <br /> Owner's Name----------- V��- � <br /> Address----•---------------------•---------------------•-------- <br /> Contractor's Name-------------------------------------------------------j-alve--------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer'.Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 'I Number of bedrooms 2,Number of baths 4 Lot size__________________��__./� l�_Q------------ <br /> Water Supply: Public system [Community system ❑ Private ❑ `JV <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑� Adobe NO"Hardpan <br /> TYPE OF INSTALLATION.AND SPECIFICATIONS: e. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r <br /> 4UA90J <br /> Septic ank: Distance from nearest well___ _________ Distance fro foundation____ _ r_____ Material------------------------------------------------- <br /> e <br /> No. of compartments �? r <br /> P +e'er. Capacity 1 � Srze X Liquid depth • <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 /> Seepag Pit: Distance to nearest-well_______________\____Distance from foundation--------------------DistanceI to nearest lot line__--______-_-____ <br /> Number of pits----------------------Lining material-----------------------Size: Ria eter-----------------------.Depth----------------_---------------- <br /> r <br /> a.Dispos Field: Distance rom ne est we _ __`� istance fr foundati ��� Distance,to Barest I lire_ _ <br /> Number o nes A of e ch e-- -- --- -------t W� th o€ tr <br /> Type of filter at rial__ ep of fil er ma 'al_ ______ _ ----- <br /> Remodelingand/or repairing (describe):----------------------------------------- --------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------- <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' regu tions of thjS3a Joaquin Local Health District. <br /> (Signed)-- - ------------------------------------------------------------------------{Owner and/or Contractor) <br /> By:------------------------------------------------------------------�---------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------- -- --------------------------------------------------------------- DATE-----------I------)-- ----!Ft----------------- <br /> REVIEWEDBY------------------------------------- -- - ------------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE <br /> Alterations and/or recommendations: -----------------------------------%-----------------------------------------------------;-------------------------------- <br /> -------------------------•--- ----------Z---- _ <br /> ----- <br /> ------------ <br /> -------------------•--------------------- <br /> --------------------------------------------------------------------------------- ------ ---------------------- <br /> --- ----- --------------------- ------------ V <br /> ----------- <br /> PERMIT N-.______� ___-_ ISSUED------ l_ _r -----fDate) FINAL INSPECTION BY___________ __ __ �__- -----------_ ---------------- <br /> Date------------------------------------ ---- <br /> ____._ -------Date----------------------------------- - _. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />