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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) I[a <br /> Application is hereby made to the San Joaquin Locaf Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION � ---------�- ' <br /> Owner's Name---------------- u ¢ ------------------------------------- -- --------------------------------------- Phone------------------------------------ <br /> Address <br /> Contractor's Name-,---.----�---p------------yy_b__���� �------------------------------- - ------------------------ --------------- Phone_,:2,1 ---p-'f----------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial X( Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: Number of bedrooms Number of baths -�/ r <br /> ❑ ❑ ❑ Lot size--------�----------x--"'�-�-�----------------------- <br /> Water Supply: Public system IN Community system ❑ Private ❑ Q <br /> Character of soil to a depth of 3 feet: Sand [❑ Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe Hardpan E] 7V <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: y <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V <br /> / r <br /> Septic Tank: Distance from nearest well___ Q___Distance from foundation-------1_ ____.Material------1 0--- _�t__ <br /> No. of compartments---------�------------Capacity_____KQ_-------Size----�3 Liquid depth------- <br /> ------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> RSize: 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 Field: Distance from nearest well---Z.04 ___.Distance from foundation_- ZOQ,------Distance to nearest lot line_________________ <br /> Number of lines--------------/--------------------Length of each line--------7_•!7�-----------Width of trench-------Zr <br /> Type of filter material ___�__ -IaSr(�_Depth of filter <br /> Remodeling and/or repairing (describe):--------------------N jo�'&------ ------- ��N�' T'4 ---------------------------------------------------- <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 anrules and regulations of the San Joaquin Local Health District. <br /> - -- -- <br /> (Signed)------- -- - (_'� �_—Ael--.--'-----------------------------------------------------------------------------------,,(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----3-------------------------------------------------- <br /> REVIEWE_D BY --- DATE -- ------------------------------------------------ <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------•--------------------------------------- DATE----------- <br /> Alterations and/or recommendations----------------------------------------------------------------------------------------- <br /> - -- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------- ---------------------- ------------------------------------------------------------------------------------------------ <br /> - - - ----------------- - <br /> ------------------------- <br /> PERMIT No __P---�_-�__ ISSUED---------- --- --- -------------------(Date) FINAL INSPECTION BY:---------------------------------.110-7-6—•-------------_---- <br /> Date / ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />