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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 with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION --- E_' 12t-h. <br /> Owners Name.....Y!rnonE_. Shrum No---n---d <br /> - ----------------------------------------------------------------- ------------------------------------ Phone---------- <br /> Address-. 1924---E------1-th,_-_-._� �E.t------------------------------------------- -------------------------------------------------- <br /> -- --------------------------------- <br /> Contractor's Name--------v-'--- -i----PAFRISH------------0S1S_--_,1NG-----------j--- -----'-------"--------------• -----. Phone---9--9-60-7-------------- <br /> Installation will serve: Residence [X Apartment House ❑ iCommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Ej Number of bedrooms [I Number of baths (! Lot size---------6_ i 8-5-1 <br /> Water Supply: Public system X] Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IMC 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-_-A1t1Sl.PDisfance from foundation___10�._______Material_9PnC.C-irC---Blx---_ <br /> ® No. of compartments______2.................Capacity__�aQ___G•____Size_ 6 �x 5�i1 ___Liquid depth_______. 2&F________. <br /> x t) deep <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- <br /> Lining material___________._-__-_-_________________- <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well____________;____________________________________Distance from nearest building----------------------------------------- <br /> ❑ Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line_________________ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------_------------ <br /> Disposal Field: Distance from nearest well___A1011e.Distance from foundation---12...........Distance to nearest lot line-------- <br /> K]C Number of lines________1� �------------W�dth of trench-------------- � <br /> ------------------------Length of each line------------- __ 11 <br /> --2 ---------------- <br /> Type of filter material_lA1��____ k------Depth of filter material---1V___________ <br /> Remodeling and/or repairing (describe)------------- [ instal-Iate=on-_--_--(F1,o_y ___13C' - ______________ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> 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 regulations of the San Joaquin Local Health District. <br /> (Signed).__.... ........►-------_----------_---------_----------+----------­--------;------'KXK)G)Q;%XContractor) <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title)------- f 3t-1inc,IC)r-------------------------------- <br /> (Plot plans, showing 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------------------ __ ----------------------------------------------------- DATE----------- <br /> REVIEWED BY--------------------------------------- <br /> ----------------- ------- ----------------------------------------------------- DATE------------,--------- ------------------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------------------------- ------- DATE------------------------------------- <br /> ----------------------- <br /> Alterations and/or recommendations---------------------------- --------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------•--------------•---•---------- •--•----------•-- --------------------- ---------------•-------------------•-------------------------------------.----- <br /> PERMIT No.__d _.------ I$SUED_.--- -Via__-S/ ----- __-_--(Date) FINAL INSPECTION BY:---------vV_--v_1_.�----------------------------- <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 />