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3 <br /> g. APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> and install the work herein described. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct <br /> This application is made in compliance with County Ordinance No. 549. <br /> ---------•-------------------------------------------- <br /> JOB ADDRESS AND LOCATION---..---r�'I° +" 'Z] Phone_ °1I a�------- <br /> W `r --------------------------------------------------------�`------ <br /> Owner's Name----------- <br /> " �' �------------- -------------------------- <br /> ------=-------- -- <br /> Address----------- --al_S-------- - ---- <br /> OjLr-------------------------------------------------------- " --- ---------------------- Phone----------------------- <br /> Contractor's Name__________________ <br /> Apartment <br /> Nouse E] Commercial ❑ Trailer Court E] motel ❑ Other � GX <br /> Installation will serve: Residence ❑ p <br /> Number of living units: [- Number of bedrooms 12� Number of baths a Lot size________ __ <br /> Water Supply: , Public system [9 Community system ❑ Private ❑ Adobe Hardpan <br /> 4 Character of soil to a depth of 3 feet: Sand [I Gravel El Sandy Loam E] Clay Loam [I Clay ❑ , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> ( P cesspool permitted if public sewer is available within 200 feet.) <br /> No septic +anktan a from nearest weli___ Q----Distance.fram foundation____.___L�D.___,.Material_______ ;--- ----- <br /> Septic Tank: D / Size----- sx__,5''-__--Liquid depth---------`-------------- <br /> No. of compartments--------- ------Capacity____��Q f <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia----------------------------------------------. <br /> ❑ Size: D'iameter-------------- ------ <br /> ----------------Dept -------------- ---------------- ------- <br /> - - <br /> Privy: <br /> Distance from nearest well_________________'________ Distance from nearest bui ing____________________________ -_ <br /> ❑ Distance to nearest,lot line________------------------"-------------------- <br /> ::., F <br /> Seepage Pit: Distance to nearest wel4-----Y1?_---------Distance.from fou�}dation__-----_---.___Distance to nearest lot line _______ <br /> Depth r�" y Q- <br /> ® Number of pits-------l-------------Lining material_�Q�N�J!-Size: Diameter_______!1'`'_______ - <br /> i.Disposai Field: Distance from nearest well___.-"�'��-_--.Distance from foundation_____���___-_Distance to nearest lot line-----_+!___._-_. <br /> Number of lines------------ -------------------Length of each line-----------�� ----------Width of french------- ---- <br /> a -- <br /> r� <br /> l <br /> f filter ma+erial�'�''�_ ---Depth of filter material_____ __ <br /> YP / VVV <br /> Remodeling and/or repairing (describe):----- -- -N-Q-W----��--���=1_;[14- -�-� -----------�----- - ------------��----•----=--- <br /> --------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------•-------•------- -------------------- <br /> hereby certifVfha I have prepared +bis application and that +he work will be done in accordance with San Joaquin ounordinances, St a lale and' regulations.of the San Joaquin Local Health District. <br /> (Owner and/or Contra <br /> i --------------------------------------------------------------(Own d/o Contractor) <br /> -•----- --- ------ <br /> (Signed) - ----- Title <br /> By:------- ---------------- ------------------------ ---------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, <br /> buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> CCEPTED BY---- _ <br /> -- -------- - --------------------------- <br /> APPLICATION A __ ___ <br /> ------------ DATE----------- "' <br /> - - -----�-- -----�- - ---------- -------- -- -- - -- DATE--- ------ ---------•-------•-----------------------•--- <br /> REVIEWED BY-----------------'-- <br /> BUILDING PERMIT. ISSUED------------------------ ----------- --------------------------- <br /> --------- ----:----------------------- DAo L`-- <br /> Altera#ions and/or recommendations:"_________- � Ir------- <br /> = '----------------------------------------------------------------- <br /> ----------------------------- <br /> ____________________"________"___ Ir <br /> ___ _ <br /> PERMIT No.__ ----3---,,--- ISSUED------(� 3 <br /> ---{Date) FINAL INSPECTION BY:_-------- -------- <br /> Date_ ----------- ---------------- <br /> ---------------------- f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 4-50 W 1639 ! - <br />