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APPLICATION• FOR SANITATION PERMIT } S� <br /> (Complete in Duplicate) <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 incompliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__ -5S-3-- -`4--F- -i-T <br /> -- ;T Tk , S j Phone----- -----r----`--L-f._- _ _---•---------•- <br /> - <br /> - - <br /> -_ _ -Owner's Name------- --!- -------t ----- ---- ---------- - -Address_____-___� ��-i_ Sc,S ------ -•------ <br /> Contractor's Name---------------------•-------------•---=------------------------------------------------------------------------------------------------------ Phone------- <br /> Installationwill serve: Residence X, <br /> Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ <br /> Number of living units: Number of bedrooms V Number of bathsD r <br /> Lot s°ze "r { ��C3 <br /> Water Supply; Public system ❑ Communit s stem <br /> � Y Y ❑ Private <br /> Character of soilto a depth of 3 feet:"Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ (S) <br /> aM1W <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1 <br /> (No septic tank or cesspool permitted if public <br /> sewer is available within 200 feet.) (f <br /> Septi Tank: Distance from nearest well__--____-Distance from foundation----1 <br /> -----___.Material----- <br /> % _ 1 <br /> J�'� No. of comparfinents .- Capacity-----�3 ---_-Size------------------------• -----}-------- � <br /> ------Liquid depth-------------------=`----- <br /> Cesspool: Distance from nearest well---_-------------Distance from foundation___________-___-_.Lining material------- <br /> _____-___________ <br /> ----- <br /> El Size: Diameter--------------------------------------Depth------------------- --------------------------------- ------------------------ <br /> Privy: Distance from nearest well________________________________________________ <br /> _Distance from nearest building ------ <br /> ❑ Distance to nearest lot line________________________•---_-_-_--_-_-._-_-- �- <br /> _ <br /> Seepage Pit. Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line ______I❑ Number of Pits---------------_•-----Lining material----_------------------Size: Diameter-------_----------------Depth--------------------------------Disposal Field: Distance from nearest well___-��b-----Distance from foundation____ 14>!7---_-Distance to nearest lot line_____-_ <br /> Number 6f-fines::------cal---____ ,�.... <br /> Length of each fine= __: _ -Width-of <br /> of trench________-"E+�F-- <br /> �� ------------ <br /> Type of filter material____ -Depth of filter material______ __-____ <br /> �-��.Q loo <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,ySfTto laws, and rules and' regulations of the San Joaquin Local Health District. <br /> (Signed) = v---I-------------"`---- <br /> - ---------------(Owner and/or Contractor) <br /> $Y� ------- ---------------------•----------••----------------------------- ------ -- --------------------- <br /> p y g --------------------------- <br /> (Plota --- - <br /> --- it a} - -- ----------- <br /> lens showing size of lot, location of system in relation to wells, buildings, etc., must-be-filed with this application. <br /> FOR DEPARTMENT SE ON <br /> APPLICATION ACCEPTED BY------------------------------- _ ° <br /> ' DATE <br /> REVIEWED BY <br /> ---=---------------- --- - --=- DATE_---- ---------- <br /> - ---------------------------------------------------------- <br /> UILDING PERMIT ISSUED ------------ ----------- <br /> -------- ------------------ ------ DATE : <br /> ----------------------------- <br /> Alterations and/or recommendations____________________ <br /> --------- -------------------------- <br /> ----------------- <br /> ----------------------------•------- <br /> ------------------ <br /> ---------------------- ---------I ----- I-----------------------------f� <br /> ( ti ------------------------ <br /> ---------------------- <br /> PERMITff <br /> No _�__0-_ _----- ISSUED----------- f-_ - a -1----(Date) FINAL INSPECTION BY---------------- --- <br /> { Date_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ES-9-2M 9-50 W-1539 Stockton, California <br />