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4 <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> ation is hereb made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Applic Y <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---------7----/------ i <br /> -------- -------- Phone------ --------- ----- -------- <br /> Owner's Name---------------------------T`-8`I------ <br /> ��-- --------------------------- --h--------------------------- <br /> ----------------------- <br /> Address-------------------- ------------------------ - . <br /> ---------------------------------- - <br /> - --------- <br /> ---- -------- --------------------- <br /> ------------ <br /> ----- ----- Pone------------------------ , <br /> Contractor's ame----------------------------------- - <br /> " A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Installation will serve: Residence p <br /> . __ \-------•--------- <br /> Number of living units: ❑ Number of bedrooms Number of baths Lot size__________----- <br /> Water Supply: Public system 19, Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand F-1 Gravel ElSandy Loam ElClay Loam ❑ Clay E] Adobes Hardpan [I <br /> �a <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______.------------Materia________-______ _______-____---------------- <br /> No. of compartments_________________ <br /> ---------Capacity----------------------- <br /> Size--------------------------------Liquid depth-------------------------- <br /> EK <br /> Cesspool: Distance from neares#-well_________________Distance from foundation--------------------Lining material-------------------------------------- <br /> ❑ Size: Diameter_-----------------------------------Depth----------------------------------------------------- <br /> 'Privy: Distance from nearest well__________________ ------------- <br /> pistance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line----------------t____-------- -------r----- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- #o nearest lot line----------------- <br /> Number of pits----------------------Lining material_.--------------------Size: Diameter <br /> ___--------- Depth--_-------------- <br /> -Disposal❑ Field: Distance from nearest well from foundation____ Distance to nearest lot line <br /> r- ------ <br /> Number of lines------- ------j ------Length of each line------------- ----- 4 Width of trench----------- --------- <br /> Type of filter material---)99� ------Depth of filter material________-___ c .----- <br /> -'` , <br /> -Remodeling and/or repairing [describe:__ <br /> 9 _ - �-�-�--- <br /> ..__ = ' <br /> =� <br /> ------- - <br /> ---- <br /> --------------- ----- ------ - ---------P -p PP <br /> ihereby cert laws aand h ales and regulations of the San Joaquin hLocalkHeall heDis}ries}n accordance with San Joaquin County <br /> ordinances, State <br /> -------------------------------- <br /> BY�:-_------K----------IP-- ---------------_--I <br /> �/] (Owner and/or Contractor) <br /> a (Signe _ -- --) 1 L-- ------------ ----------------------- ------------------------------ <br /> -]- - ----------------- <br /> Title <br /> - - ------------------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). <br /> FOR DEPARTMENT USE ONLY <br /> ---- DATE--------1 �` --------------------- <br /> APPLICATION ACCEPTED BY------------------------ -- = <br /> REVIEWEDBY--------------------------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE --- - <br /> Alterations and/or recommendations-------------------------------------------------------------------------------------------- ----------------------------------- -- �!r- dh <br /> --- <br /> -- � <br /> 5�G <br /> w"_..,, <br /> --- --- '� = N------------------ <br /> ---- ----------------------- <br /> pate FINAL INSPECTION BY __ X <br /> _ <br /> Date <br /> PERMIT No. -a-, -------- ISSUED----� oZ- -- ---------- { � <br /> ------ ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT F <br /> 130 South American Street �� <br /> Stockton, California <br /> k <br /> ES-9-2M-9-5D W=1b34 -d _ <br />