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9- v <br /> APPLICATION FOR SANITATION PERM 1 <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct an II orlk herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION- ---- Z- --6------- ---�!---- —' --- ------------------------------------------------------------------------------ <br /> Owner's Name i - �= -�� '----------------------------------------------------------- Phone <br /> Address- 1 -- -------------------------------------------------------------------------- <br /> Contractor s Name ti � .4'.Kf'=-!-✓--------------------------------- Phone---*.c., `f =s <br /> , . <br /> Installation will serve: Residence ❑ Apartm�nt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: V Number of bedrooms Z& Number of baths Z Lot size---- __________________________ <br /> Water Supply: Public system/N Community system ❑ Private ❑ (� <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�K Harclpanj�( <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: c ;' <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 /> ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- <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 /> ❑ 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 /> Disposal <br /> -._Dis al Field: Distance from nearest well____ ___Distance from foundation___,',--'Q_______-Distance to nearest lot line i;--------------- <br /> Number of lines_______________ . -----------Length of each line___________-�__._ ��.Width of trench..__ G __________ <br /> Type of filter material__ �`_q_--?��.Depth of filter material.___•.__, .___._ <br /> Remodeling and/or repairing (describe)---------------- -------------------------------------------------------------------------------------------------- <br /> -- -------- <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 regulations of the San Joaquin Local Health District. <br /> (Signed)-_- - - -` i_Ca`_z----- ���----------------------------------- Owner and/or Contractor) <br /> BY: - ----------- - (Title) 1 -`� =`'� <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_ - <br /> ------- DATE----- �.__.-_ <br /> ------------------ <br /> _=------------- <br /> DATE--------- --------�?---- -------------REVIEWED BY ---------- <br /> BUILDINGPERMIT ISSUED---------------------------- -------------------------------------------------------------- ---------- DATE------------------------------------------------------------- <br /> Alterations and/or refommendatiops:� , ) -------- -I------ -------------------------------------------------------------------------------------------------- <br /> ---------•------- a --------- a[_s�11- _ F +----- �--� ---fJ�lt/'4,�/J--• 1 --------------------------------•----------------•----------------- <br /> -----------------------------------------------------I---------------------------------------------------------------------------------------------------•------------------------------------------------------------------- <br /> --------------------------------------------------------•------------•------ ------------------------------------------------------------ ---•----------------------------------------------------------------------------- <br /> ------------------------------------- ------ ----------------------------------- ------------•------------•----------------------------------------------------------------------------------•--= --------------------- <br /> - - <br /> PERMIT No..--Tb P-----------ISSUED-----9 --1.2- S--J-------------(Date) FINAL INSPECTION BY:---------:- ------------------------------------------------- <br /> Date------------------------ ----- /`---------t------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />