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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San oaquin Local Health Dis rict for a permit to construct and install the work herein described. <br /> This application is made in compliance with <br /> County Ordinance No. 549. .5E 6 <br /> JOB ADDRESS AND L C TION...... ...�✓ _ •• _ <br /> . <br /> Owner's Name...._._. �l ! <br /> - ------- ----- <br /> •-=------ - <br /> ----- �-4'u---------....----•--•-•----...-----••-•--��one_...------••----._...------•----- - <br /> Address �"Z• L''C -- ------ ------ =..............................._................................... <br /> Contractor's Name-- --•--- ---------- ---------••- •-----..-..----------------------•---.------ Phone............................... <br /> Installation will serve: Residenc Apartment House ❑ Commercial E Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms Number of baths V Lot sizb- <br /> Water Supply: Public system ❑ Community system ❑ Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay (� Adobe❑ Hardpan E]TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 <br /> Septic Tank: Distance from nearest well-A-P-----Distance from oundation__..��._..__.Material----- t. t^P _ <br /> t <br /> No. of compartments.............-�_..Capacity.......Y�..___Size-��(_�,�.�'-------Liquid depth.......�-. -------- <br /> C <br /> Cesspool: Distance from nearest well..................Distance from foundation..................:.Lining material___......._....__.._._..._ <br /> ❑ Size: Diameter......................................Depth................... •-----•---..................... <br /> Privy, Distance from nearest well.................................................Distance from nearest building........................................ <br /> 11 Distance to nearest lot line..............................................•. <br /> Seepage Pit: Distance to nearest well......................Distance from foundation...._............_Distance to nearest lot line.--_____--------- \ <br /> ❑ Number of pits__---_-__-_---------_Lining material.......................Size: Diameter------------------------Depth......................----------- <br /> Dispo al Field: Distance from-nearest well.JO._a-___.Distance from foundation-294-.........Distance to nearest lot line.. <br /> Number of lines-------------- ........ ...... Length of each line____..1.� Width of trench..__----__ ff ,r----• -- ---•--------------- <br /> Type of filter material_-, i,t,,� o Depth of filter material._.../.. ........... <br /> Remodelingand/or repairing (describe):......................................................................................................................................................... <br /> .........................••.........•-------•-----••---•._...---•---•---•-•-•----...---•-•.---------•--....._...-------------------•--------------------------------- ----------------------------------------------------- <br /> I hereby certify that 1 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)..._._- -•--------------------/ _--- (Owner and/or Contra <br /> By:.. -- -- --..... •-------------••---•----------•--------------------------(Title) <br /> (Plot plans, showing ize of lot, location of system in relation to wells, buildings, etc., must be filed with this application). '(( <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY............................. ... --•- ..... •••• ......................................... DATE.......-- ----- <br /> REVIEWED BY... -•-------------••----•------•-••-• --••-•• • DATE -� •' S ... <br /> BUILDING PERMIT ISSUED------------------------• ••----• • DATE..........................�6o. <br /> --------------------------•-------•----------------------....- <br /> --------------------------------- <br /> Alterations and/or recommendations: .... ........ <br /> .............................................................-----------------------------------•-••------------....-•--------•---•--------......----------•-----.....------•---••---._._...------------------------------- <br /> -•--------------------•--------••-•-•-----•••----•-------------•-••---•----------------------------•••---------....---•-•-•-•--•.......•-----••----•-----•-----.....----------------••• ...................................... <br /> .................................-----------------••-•------------•-----•--•---•----- ....................................................................................-------•------------------------------------------ <br /> ----- <br /> ------------------------------------ <br /> ------- --------- ---------------- <br /> - ---- -- - --- ------ <br /> PERMIT No.3-7 .-I_ ISSUED-- �S - ,.'� (Date( FINAL INSPECTION BY:.....--- -- ------ <br /> Date-Date.................... <br /> ---------------•--• --------••.......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=Mq <br />