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t <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> f Application is hereby made to the San Joaclpin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compfiarice with County Ordinance No. 549. <br /> t <br /> JOB ADDRESS AND LOCATION...- .-, _ ,C e'7"� <br /> Owner's Name o h/ <br /> ---- -------••----------------------------------------------------------------------- <br /> �` '!'�Vv-------- K <br /> Address `T t►. --- , <br /> - Phone--�--F.S.S.- <br /> ...-. <br /> --------------------------•-------------------------- ------------•------------------------------ <br /> Contractor's Name--------------------•T�_�-,_- ----tl--1n/-- <br /> --. _ Phone <br /> • ------••-•---•---•- __ _ <br /> Installation will serve: Residence K Apartment House ❑ Commercial <br /> • ❑ Trailer Court ❑ Mosel ❑ Other ❑ <br /> Number of living units:; -Number of bedrooms 5 Number of baths R Lot size--- <br /> .,,,Wafer Supply: Publics stem � ... <br /> Y ❑• Community system ❑ Private <br /> Character of soil to a depth of 3 feet: Sand E] 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.) 1 <br /> Septic Tank: Distance from nearest well......El ...........Distance from •foundation--------_...____.__.Material----------------------------------------------- <br /> No. of compartments --------•---.Capacity-----------------------Size----- -----•--------------•--Liquid depth------ _ __ <br /> -----•-------- - <br /> Cesspool: Distance from nearest well.................Distance from foundation.-._____-___--------Lining material__._...._.._..._. <br /> F1Size: Diameter.- -------•--------.-Depth-----------------•---••- <br /> --....-. _ <br /> Privy: Distance from nearest well________________________________ Distance from nearest building Distance to nearest lot line----...... -- g•------•-•---•------------•-----•--------• <br /> Seepage Pit: Distance to nearest we -__.._-. <br /> llg _ <br /> ---__Distance Distfrom,foundation..._ <br /> Distance to� / ..:... nearest lot line--.-- __--- <br /> Number of pits................•....Lining material__.(,_k}G_t_-Size: Diameter.____. __ '� <br /> J( Depth.---- ;' <br /> .Di. osal Field: Distance from nearest wefl_-__-=_:^..._.Distance from foundation---.t __.!--___.Distance to nearest lot line_________________ <br /> Number of lines______ Length of each line...._-___.._ <br /> Type of.filter material-............... Width of trench...-.._..-_.'�.....__ ' <br /> -_-._.._-Depth of filter material______ _ ""'------•.--�- <br /> Remodeling and/or repairing (describe)_________________ 11 <br /> 7�a 4'-------- <br /> ----------•----------------------------------- <br /> ------•---------•-----•--•---------------•-- <br /> -- -- - f --- --- <br /> pared this application and that the work will be don--------------•--------•----•-•-----------•-•---------------••---------•-•-------••------•--------------------------------_....- <br /> ce in accordance with San Joaquin County <br /> 1 hereby certify that I have pre <br /> ordinances, Stat an ul and regulations of the San Joaquin Local Health District. <br /> E <br /> (Signed)--------- - <br /> ~ ._..__. --•------------------ er-and/or Contractor) <br /> BY --------------------- ................ <br /> -----••----- y <br /> (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--------------- _ <,­ 1 <br /> DATE...-_.- ---- <br /> REVIEWED BY y� <br /> BUILDING PERMIT ISSUED----------------------------------------------- - DATE ------ --------- -- -- -------•-----------...- <br /> Alterations and/or recommendations:__-!_________________--_-__•--_- <br /> ------------------------•----------------••---------- <br /> ---= <br /> -- --•- <br /> ................................................... <br /> ------------------------------------------------------------•-------- - <br /> PERMIT ... ISSUED ISSUED._..-.- s ------- Date) FINAL INSPECTION BY:___--_____. Aj <br /> -_-� <br /> Date..................... ! <br /> r � l <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> E5-9-2M 9-50 W4639 Stockton, California <br />