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APPLICATION FOR SANITATION PERMIT 16j /Y 2,1 <br /> (Complete in Duplicate) <br /> Application is hekeby made to the San Joaquin-Local Health District for a ermit to constru t and install the work her ' d ri d. <br /> This application is made in compliance with County Ordinance No. 549 � �`' <br /> lOB ADDRESS AND L�__CATION_____l��iK` - - - <br /> Owner's Name------------ -----------s.)_ Phone_[s�- r_ <br /> Address ' - ---------------- . w+i <br /> Contractor's Name--------�--3--1-_F--L--4 pl---------1(----- --------------- ------------------------------------------------- Phone----------------------------------- <br /> r <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:X Number of bedrooms � Number of baths Vf Lot size______ �_1_____________________ } <br /> Water Supply: Public stem y� F]Community system ❑ Private ? <br /> Y <br /> Character of soil to a depth of 3 feet: Sand ❑ 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.) <br /> Sep ' 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 /> See a e Pit: Distance to nearestwell---_ -------Distance from foundation---(---______ istance to nearest lot line__________ � <br /> ( Number of pits----/ _-�---Lining material------=----------------Size: Diameter_e _.Depth__? <br /> TQC <br /> Disp sal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-----___-._-...._ <br /> Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material-------------------------Depth of filter material __------------._____ <br /> t 11 <br /> Remodeling an or repairin ( scribe :---------�s rs�' i-------- • - ---'-'�- i ; --------------- ------- <br /> rQ - ' .... ----------------------------- <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 I s, and rules nd regulations of the San Joaquin Local Health District. <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 t � { c�} <br /> ------------------ -------------------- <br /> REVIEWED BY------------------------------------ - ------- ---------------------------------------------------------------------- DATE------------------- <br /> ------------------------- <br /> BUILDING <br /> -- - - ---- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------- ---------------- DATE-------------------------------- <br /> Alterations and/or recommendations----------------------------------------------------------------------------------------------------------•-------------------------------- <br /> ------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------•--------.---•-----------------•----•---------------------•----------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -•--------------------------------------------------------------------------------------------- --•--------------------------------------•-------------------------------- ------�°` <br /> ------------------------------------- <br /> PERMIT No------------------------- ISSUED------------------------------------------(Date) FINAL INSPECTION BY:-?--------------------`- ----------------------- ` <br /> Date-- r ------------------------------•------- - <br /> SAN <br /> ----- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> I FS-9-2M 9-50 W-1639 <br />