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APPLICATION FOR SANITATION PERMIT 8 <br /> (Complete in Duplicate) ' <br /> Application is he:eby made to the Sen Joaquin Local Health District for a permit to construct and install th work herein described. <br /> This apf licetien is made in compliance with County Ordinance No. 549. <br /> 1/ � A' 1 / <br /> JOB ADDRESS AND LOCATION. vim.?..............? _.l .v '?S G.!v /Vv'� _?- �1.t o.� { ..' movr� <br /> f ......... ......... —:_ C _- ...... f' ......._......_ <br /> Owner's Name_....... ................ D............ ...... Phone........ ....._..--•-•----•------ <br /> Address......................................•-...�...ba.�t//.........................................................----------....................................................................... <br /> Contractor's Name......................................a Li/ ) P.!._.............._. ...... .......... Phone......................... <br /> - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ❑ Number of bedrooms J2�--Number of baths 0 Lot size........L....�-.'�..Z..�-5-................. <br /> Water Supply: Public system ❑ Community system ❑ Private, <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loarn ❑ Clay❑ Adobe)�r Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - <br /> fi <br /> Se tic ank: Distance from nearest well._.........Distance from foundation.......�-- ...Material................-C!LL t......_.._..... <br /> No. of compartments............--..........Capacity.... ........Size----4?S.9^ 7....Liquid depth...................... <br /> Cesspool: Distance from nearest well.................Distance from foundation..... ............. Lininn 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......................Distance from foundation........ .........Distance to nearest lot line----------------- <br /> El Number of pits......................Lining material.......................Size: Diameter...................__..Depth................................. <br /> Disp I Field: Distance from nearest well�.._.......Cistycp�m foundation.,-./O...".--...Distance to nearest lot line......~)_....... <br /> /`�f� Number of lines........j: ?'r................Length of iacls�iwec....._..�. Width of trench.......- -.�. <br /> Type of filter materiel..�.t')_,,.�a4}tDepth of filler material......./. ..�..... <br /> Remodeling and/or repairing describe):----- - . .... ....__........ ...................................-----------.......----------------_-----------------.............. <br />._ ...........•---.....-----...... . ..... ...... ......I........................•-----•----............ .....--............•. . .-----..................................................................... <br /> ...........I........................... . ............................. .... ..........••........................................_.. ._..------............. .---. ..............----•--- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance wit~ San Joaquin County <br /> o,dinances, State laws, and rules and regulations of the San Joaouin Local Health District. <br /> (SigneBylAd) _ -.(Owner and/or Contracto,) <br /> j _..Title............ - ------ . <br /> (Plot plans, showing size o ot,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 /> .., TW_17 <br /> : DATE.... <br /> REVIEWEDBY_............................._... L ............ ... ._....................--- ...._.._..-- <br /> BUILDING PERMIT ISSUED..------ .... ... .... ......._---.---..._.. DATE _..... -.................. <br /> Alterations and/or recommendations: ....... .... ... . _ . ................................................................ <br /> ............................-................................................... _... - _ -..-......._...... .._ ... .. .... ... .............. <br /> _.................._......_..................................................... ......_ ... . ........ ................... . <br /> - - ............................ <br /> . _.._.. _ _. _ .................. ............................ <br /> PERMIT No..U...-/....!...-.. ISSUED.... ..../.? �._/ _ (Date) FINAL.. INSPECTION BY:�...�L//.rt{'.��:.�,:, �:4ar.......... <br /> �J <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ... 130 South American Street <br /> Stockton, California <br /> IS-9-2M 9.50 W-1639 <br />