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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 wit C unty Ordinance No. 54 20 3_A <br /> JOB ADDRESS AND),O <br /> -,ATION___ - ----- - --- - ------ ---------- ----- - --- ----- --------------------------------------------------------------- <br /> Owner's Name--------6V------- ---------- <br /> -4� - ----- --- ------------------------------ <br /> -------- Phone------------------------------------ <br /> Address--------------- <br /> Contractor's Name--- - ---- <br /> ------------------------------------------ phonet ------- <br /> Installation will serve: Residence E] Apartment House E] Commercial E] Trailer Court E] Motel E] Other Ej <br /> Number of living units: -E] Number of bedrooms El <br /> Number of baths E] Lot size- ----412�_ ------ <br /> Water Supply: Public system Community system F] Private E] <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Ej Clay Loam F] Clay EI Adobeo Hardpan E] <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 /> Fl No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth------------------------- <br /> cesspool: Distance from nearest well-----------------Distance from foundation-_------.-.------.-lining material__----_______________-_----.--------- <br /> 0 Size: Diameter--------------------------------------Depth----------------------------------------------------- <br /> "Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___----__----____-_____---___------------. <br /> ❑ Distance <br /> uilding----------------------------------------- <br /> Distance to nearest lot line------------------------------------------------ <br /> Se pa e Pit: Distance to nearest --------Distance from fcnndafion____,,S'6__' Distpinctto nearest lot line__-c�---------- <br /> j <br /> V Number of pits--_-_--7---------Lining material---- -------Size: Diameter_____,m7__6---- DePth____,2A0__/--------------- *1% <br /> Disposal Field: Distance from nearest well------------------Distance from foundation-----------------.-.Distance to nearest lot line_-_-___---------- <br /> El Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type <br /> rench--------------------- ------------- <br /> Type of filter material-------------------------Depth of filter material-_--------____________ <br /> -Remodeling <br /> aterial----------------------- <br /> -Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------------------------------------- <br /> I hereby cerfify,fhat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rulps-4nd regulaflons of he San Joaquin Local Health District. <br /> (Signed)----- _"I -- ------------------------------------ AOwn X /or Contractor) <br /> -------- -- --- <br /> By:---- 1------------------------------------------------------------(Title) ---------------41COO-07 <br /> --------------------------------------- <br /> (Plot plans, s. owing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- --- -W_ ------------------------------------------------------------ DATE----- <br /> REVIEWED � ----------------- <br /> --BY------------------------------------------------- 4---------------------- --------------------------------------- --. DATE--------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------- <br /> ----------------------------------------------- -------------------I--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------------------------------------------------- <br /> ---------------------------------------------------- --------------------------------------------------=-------------------------------------------------------------------------------- <br /> �/ 4---------------------------- <br /> PERMIT No----- ....... ISSUED--- -------------------------------(Date) FINAL INSPECTION BY:------- -------------I----------------------------------- <br /> Date---------_1------1- - --------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />