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?j l APPLICATION FOR SANITATION PERMIT <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 9. <br /> JOB ADDRESS AND LOCATION.- -1 sz`'-/_---_------- r----- ,--- ---C-_�-0114......�_�____�__f_----_-- .+ /blew <br /> Owner's Name ��j-------------+r----- -�� �1 �4� ----------------- Phone_ <br /> /_7�7 <br /> Address-------------------------- ------------------------­----- ------- --- - ---------- ---- <br /> __�Co , -____ Phone.-5.P_ f ___--- <br /> ntractor's Name____________�_a... ••--- 7 <br /> Installation will serve: Residence % Apartment House ❑ Commercial ❑ Trailer Court ❑f ElMotel ❑ Other <br /> Number of living units: 1Z Number of bedrooms a Number of baths Z Lot size__!P__0_54---IS ___________________________ <br /> 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 /> Septic Tank: Distance from nearest well_--------------Distance from foundation________•-•________-Material______-____--_-_______-___-____________________- <br /> ❑ No. of compartments--------------------------Capacity_________________•_____Size--------------------------------Liquid depth________-______ . <br /> -Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material____________________________________ <br /> ❑ Size: Diameter-----•-------------------------------Depth---------•------------------ --------------------- <br /> 'Privy: <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--_-__._.._____-_______________-_--______- <br /> ❑ Distance to nearest lot line___________________________________________ <br /> SeVpa Pit: Distance to nearest well---- _______Distance dfrom foundation__._$.......Distance to nearest lot line_______ <br /> Number of pits__Q-�i�______Lining material... r'1_�t<+�r---Size: Diameter..1S___�'____-------Depth.,X%.►'C!___________-:__ <br /> Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line..._....... <br /> ____._ <br /> ❑ Number of lines___________________________________Length of each line_________-____•-___-_______-_-Width of trench___.__-_________________-_________ • <br /> Type of filter material________________________Depth of filter material_______________________ <br /> Remodeling and/or repairing (describe):------- ------------------------------------------------- <br /> ..d - -;c_? �_!�! 0 .� t_ .-- ' __:/ -------------- <br /> -------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------- ------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordihances, laws, and rules a guletions of the S Joaquin Local Health District. <br /> (Signed) ct---- })_ _ _( _ _ _,tS/,$ _---_ {------------ -- --(Owner a Jar Contractor) <br /> BY�----------- ._ r ------------------- (Title) -------- -- -- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed ith this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATES r. ,/�r`-------- ---------- <br /> REVIEWED BY----------------------'-------------------------------------------- -------------- ------------------------------------------ DATE; _-------------------------- <br /> ----------------------- - <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE` -------------------------- <br /> Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------•------------------------------------•- <br /> -------------•---•----------------- -------------------------------------------------------- --------------------------------------------------------------------------------------------•--------------- ------ <br /> PERMIT No../Q.,3.J------- ISSUED_____ _ ________(Date) FINAL INSPECTION BY:------- -__________ _------------------ <br /> Date------_--------- <br /> ________ ___Date---------------- f-------------------------=------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />