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APPLICATION FOR SANITATION PERMIT Q <br /> 42-10 (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------------ --- ---- ------���......" -5-x------------------------------------- <br /> .................Name.....-•-•.....................•---....T�_. �+tt1l .�G!1..._.. ...... PhoneA.:,fAa-T..----------• <br /> ....................... <br /> Address--------------------------------------------------- afc°'sxx.......1094---------- _ -----------•------•---•--•-------------•-------------------..------ <br /> Contractor's Name........... -.�f.waist.. -tlr---------------------- Phone----5�..=44-0--7......... <br /> Installation will serve: Residence It Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: V Number of bedrooms Number of baths ❑ Lot size-el,-XXX___.Z-____ _____________________ <br /> Water Supply: Public system ❑ Community system ❑ Privatex v <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe X Hardpan ❑_ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: \ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> � <br /> eptic Tank: Distance from nearest well................Distance from foundation......-............Material------------------------------------------------- <br /> 4%� 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............................................... C,,L&, ..-4w.., <br /> o� <br /> Seeps a Pit: Distance to nearest well._./� .___ <br /> ,k__. Distance from foundation--------------------Distance to nearest lot line-.............. <br /> Number of pits_____../________.._Lining material-eg�&-)4----Size: Diameter__!!. Depth.__�.,r_.__ <br /> Disposal Field: Distance from nearest well..................Distance from foundation....................Distance to nearest lot line..._............ <br /> �.cA> Number of lines...................................Length of each line------------------------------Width of french...................................�J <br /> Type of filter material.........................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, 7rue�"nd <br /> regulations oft S San Joaquin Local Health District. <br /> (Signed) ttQ�d t` dtlt...._...-. tau------------••.....................•-..._. Contractor <br /> B :------ ------- -/-! ..... `= --------- ------------------------------------------------ (Title)-��fJ!irx ar �-------------------------- <br /> (Plot plan , sh`win a of lot, location of sys.7 .m in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B -- ------ ----- DATE <br /> REVIEWED BY DATE --•--------------------•--•-------- .._.. <br /> BUILDINGPERMIT ISSUED.-------------------------------------------------------------..............-....................... DATE------......_�y.....__......__......__._....---------- <br /> Alterationsand/or recommendations:...........................................................................................................------------------------------------------------ <br /> ----------------••--------....-.-------•---•-•---••--•-.------------•--------....-------•------•--........-•--••---......_....------..........._.._...---........._...----.....----•------...-••--...--------.-............ <br /> ..........-•-•--•............................••------•-••----•--•-•-------_....-•---•------•---------•-------•---•-------...---•---------•----------••-----•••----••---•.-.._...-•-•••---...-----......_..---............ <br /> -----------------•..........................................•-----•-••-•---...-------•--........-----------------------------......•-....-....--••-----------..------............--•---........._......--•---•--•......_.... <br /> -••----------------•----......p............................ <br /> ..... <br /> ................. <br /> .... <br /> ... <br /> . ..........._..--•.---------------•--------•----------------------------..._......._........._...----•-------------- <br /> PERMIT No.. -c-----d........ ISSUED._...y Z.S.-...a7____(Date) FINAL INSPECTION BY:--------- ✓__.� ................... <br /> Date--------•--------7-*----------6.1-:4 -/............................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />