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1 <br /> O rI <br /> APPLICATION FOR SANITATION PERMIT 9 Y <br /> (Complete in Duplicate) <br /> Applitefion is hereby meds to the Sen Joaquin Local Health District for a permit 4o construct and insiell the work herein described: <br /> This application is made in compliance with County Ordinsnce No. 549. <br /> Si JOB ADDRESS AND LOCATION.......F:..Ie.P&._A.A4........4.....FR.Ao.n�.ct..Fk..._A.M.P. AD.....-....f.xr-l-+s...N..._ .. .>+�.P.... <br /> Owner's Name..._.....W.Vy......O.VL.CI{....................................................................................--......-...... Phone.................................... <br /> AddresL.._.. A ................. F. <br /> '. ..._..........I....._.................._..............._... <br /> ( Contractor's Name._-....._....................._.._............_...._....._........_......................__........------__.......-----. Phone...—................ <br /> ....... <br /> _.. <br /> Installation will serve:. Residence [X Apartment House ❑ Commercial [3Trailer Court ❑ Motel ❑ Other 11I <br /> ¢ Number of living units: m Number of bedrooms I Number of baths QL Lot -------------------- <br /> Wafer Supply: Public system ❑ Community system ❑ Private <br /> p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loan,X Clay Loam Clay❑ Adobe❑ Hardpan ❑ <br /> .!S 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 /> f ❑ No. of compartments.........................Capacity...............—....Size..._.___........_.._Liquid depth.......................... t <br /> I Cesspool: Distance from nearest well..._..........Distance from foundation....................Lining material.... <br /> ❑ Size: Diameter....'_...............................Depth......................_........................_ <br /> j privy: Distance from nearest well............................................_...Distance from nearest building..................... .......... <br /> '�1 J <br /> 1] Distance to nearest lot line....._----------------------------- ---- � <br /> Seepage Pit: <br /> Distance to nearest well--i" <br /> .Q......Disfance From foundation....614..r.....D'si tr to nearest lot lina.�.' <br /> IYg' Number of pits........ inmg material.,5x1Sr_1S...Size: Diameter.........._.,Depth...... ....._.1_/. <br /> ( Disposal Field: Distance from nearest well..................Distance from foundation....................Disfanca:to nearr,st lot line.__............ ,a <br /> j ❑ Number of lines..._......_......................Length of each line_................._.........Width of trend,................................... 1S` <br /> SType of filter material.........................Depth of filter material.................... <br /> i Remodeling and/or�..°1.qe-rin P striLl1.1.1 ....1:::::ail.Qf::: : :::::ah-----...'1' is ':J�: .... j h.�t.._.Ir.(/..'.e`.�__.�_ ...._............ <br /> 4 .. l! ...... . D .... .. - <br /> ...................................................................................................................................................................................._... <br /> .. .......---......_....._... <br /> I hereby certify that I have prepared this application and the+the work will be done in aeeordenee with San Joaquin Counfy <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Hea'fh District. <br /> St ned ... (Owner and/or Contractor) <br /> By:-•---....._.....-......._.....................................................................................-----..._(Tifle)....... ._._-....._.......-_-----------------._..._�� <br /> (Plot plans,showing sae of lot,location of system in relation to wells, buildings, etc., must be filed with this application). <br /> R DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY.............. . .................................................................. DATE-----.....:J.. ......sr�.. .�.r.-.- <br /> REVIEWEDBY......._........_...................................................................................................... DATE............... ........._.. ..................----.... <br /> j BUILDING PERMIT ISSUED.---.............................._................................................................. DATE............................._..........._............_ <br /> Alterationsanti/or recommendations:......................................................................................................................................................... <br /> : <br /> ....................._....__.................................. 1........................................................................................................................11............................. <br /> ............._.................._....................................._.................................................................--......._..............._.._.........._..........-................... <br /> .. <br /> t <br /> .............._...................................................................................................................—................................ <br /> ............ ... .............. <br /> .._...._..................._.................................. . .......................................................................................... . ........................... <br /> .pp <br /> PERMIT Noa.-i��....L.V...... ISSUED....... ' .........(Date) FINAL INSPECTION BY:....::.. . ..... .... ................_............... <br /> jDate..._.........._.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton,Cali'om*.a <br /> ES-9-2M 9.50 W-I639 <br /> t <br />