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APPLICATION FOR SANITATION PERMIT I <br /> (Complete in Duplicate) 41 <br /> OZ7 - b&0—o6 <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to onstruct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOC TION L2Sr...-.Y..Q.-. .... <br /> �.l��r - T� L^ ✓.is .1------------------------�3 <br /> Owners Name.. -- .y.....................................- - .... -------- .....-. Phone--------- <br /> Address--------------- <br /> ----..Address________________O <br /> 40.41 <br /> Contractor's Name_..-_. -� i-------..... --------!•-'Y1----------------------F>---------_------------------------- --- Phone---------------............... <br /> Installation will serve: Residence 5. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .. <br /> Number of living units: I)] Number of bedrooms m Number of'baths q] .Lot size__�....�SJ_&----------------- --............ <br /> Water Supply: Public system ❑ Community system ❑ Private K j(I <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam❑ Clay ❑ Adobe❑ Hardpan❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /PPtQ W404— <br /> Septic Tank: Distance from nearest well./.QA_{_'_?!aistance from foundation__/��J............Material---edept <br /> __ __�_�•-j��yi�,�-� <br /> (� No, of compartments.....__.Z__......_..Capacity---$OP_ L.-Size....l.__ .. :�1!_:_Liquid depth..` <br /> Cesspool: Distance from nearest well ..............Distance from foundation_..................Lining material__-__-._._._---_.-__,_-. i <br /> ❑ Size: Diameter-..............-.._------........_Depth ....___ <br /> Privy: Distance from nearest well...............................................Distance from nearest building-----------_ -----__-_-----__________-_. <br /> ❑ Distance to nearest lot line................................................ <br /> Seepage Pit: Distance to nearest well____.--------.----Distance from foundation--------------------Distance to nearest lot line....._____._._ ' <br /> ❑ Number of pits....._..-_----_----Lining material..........._..........Size: Diameter..m_r,- ......Depth...................._.........- <br /> '.Di4posal'Field: ""Distance from nearest-well.EQR.T-2--.-.-Distarce4i:6m+founda),ien Distance-to nearesiaot-line o-�___ <br /> .T <br /> ® Number of lines...... ---_.....................Length of each line.'.�;�.'.:...........`....Width of tranch,..$_k.......................... <br /> Type of filter ..._..----.Depth of filter materials - - -------- <br /> -Remodeling and/or repairing (describe):------- --------------•--------------------------------------------------------------------------------------------------- <br /> -•--------........•-- ..................... .......................•-.....................................................------------------------------------------------------------------ <br /> ------------.------------------------------------- ---------------------------------------•--------......................---------------------------------- -- ------- <br /> I hereby certify that I have prepared this application and the+ the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. <br /> (Signed)......---- -•r`_--�. . `�[.-----.................. --` -- ---- ---------------------, _---------(Owner and/or Contractor) <br /> By...............-----------__----------- ---------------------------_-----_--------------------------(T'tle)-------------------------------------------- - ------------- <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 g r�, -��' .--•---------- <br /> REVIEWED BY. - ------_-----------------_.--...._..__.............__-------_-_----------._ DATE-.. ------ — ....--......... <br /> _— <br /> BUILDING PERMIT ISSUED....................-...----------------------------------................................... DATE-----_.......................----------• --- ---- <br /> Alterations and/or recommendations................. ---.......... <br /> ----------- <br /> --------- __. . ..-- <br /> ..........................._......--------­---------------------' /---------------............---.........-.. - <br /> . _ <br /> PERMIT --- ISSUED.._. � __Sl.............(Date) FINAL INSPECTION BY:....... -....-............ <br /> ---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> y <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />