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syG <br /> APPLICATION FOR-SANITATION PERMIT <br /> in Duplicate)(Complete P ) <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. �L <br /> JOB ADDRESS AND LOCATION----- __ _-- --------- -- --.-...-------------- <br /> Owner's Name--------------------------6/-i-- --------- -v-----/ ---'---------------------------'-------------- <br /> Phone_ <br /> Address---------------------------------------------- —---------------------------------- <br /> Contractor`s Name-----------------#----------------------------------------------------------------------------------- -,------ - Phone-------------------------------- - <br /> ----------------------------- - <br /> Installa+ion will serve: Residence;XApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ofher <br /> �❑ <br /> Number of living units: ❑ Number of bedrooms E� Number of baths [Z Lot size_____ -/l4�_-_.X____!+-__!_______________________ <br /> Water Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam W Clay ❑ Adobe.WHardpan ❑ ; <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ••r(� <br /> (No'sep+ic tank�or cesspool permitted:if public sewer is available within 200 feet.) Material._.;CQ G <br /> 6is <br /> Sep® Tank: No+of compartmentsfanc`e from --.-----well_ tDistance Capacity from foundatiSrze_ 6_X �� � Ligwd depth-_-_-- ��_______ <br /> Cesspool: <br /> } <br /> Distance from nearest well-----------------Distance from foundation_______________.__.Lining material____--___-__________________________-. <br /> ❑ Size: Diameter-------------------'------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> F Distance to nearest lot line------------------------------------------------- <br /> Seepage <br /> ______________________________________________ <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 /> Disposal Field: Distance from nearest well- r� _�-.Distance from foundation y�____-_-Distance to nearest lot lin __� ______ <br /> ® Number of lines-------------/--------__-------__Length of each line___---___ ;�_-.___r�___.Width of french______Ay- <br /> Type of filter material____'1/4— _____Depth'of filter material_____ _ -------- <br /> 'Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------- •--------------------------- <br /> ----------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------------------`------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I 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' regulatio s of the San Joaquin Local Health District. <br /> Z6- <br /> (Signed)-------- �� -- ------------------------------------------------------------------------=--------------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- <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-------- 1--------------- <br /> REVIEWED.13Y-----------------------•----------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-------------------------------- - <br /> Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---•----------------------------------------------------------------- -------------------•------------------------------------------------------------­-­---------- <br /> PERMIT No______ <br /> L�' ISSUED--------- 1----7 �------(Date) FINAL INSPECTION BY---------------------------------------------------------------- <br /> ________ <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 />