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• 4 i <br /> APPLICATION FOR SANITATION PERMIT/ <br /> ,fff <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 in compliance with Coyinty Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION- ol � 1_ ?_^!_c , <br /> ---------------------- <br /> Owner's Name----------- `e C----- �'= 1 " --------------------------------------------------------------- <br /> -- <br /> - ----------------- --- ------------ ---------------- --------------------------------- Phone--Ovzcp'iQ -------- <br /> Address-------------------- • 4�{ -�--'- <br /> Contractor's Name .` 4� - ::C"--------------------------------------------------- ------------------------------------------ Phone---------- <br /> t - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ _Motel ❑ Other ❑ <br /> Number of living units: . Number of bedrooms,7J Number of baths Lot size------ --v-�_ -_ <br /> Water Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ 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 /> Septic Tank: Distance from nearest well----y�----Distance from foundation_____--�D------Material------- <br /> L�t� <br /> No, of compartments_______----------Capacity...��__ ------Size----1_ __ -I_ -_i------Li uid depth __ <br /> _____________-- <br /> qp --------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material____- __-__------__-__--__._ <br /> ❑ SIZE: Diameter y-------------------------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 _„_iDistance_,frckM=foundation=7�' ”'---his ance"'to nearest lot line____.----_ <br /> R.. NumEer of"lines------ '�`--€-__`-_ _Length of each lines <br /> (� g - -----Width of trench_-----' = <br /> Type of filter materiaUA_ _;�'___! ,Depth of -filter material__----I_��-____-__-- <br /> 'Remodeling and/or repairing describe :---__r---__-- - _�, ------- <br /> ------------------------- ---------------------------------------------­------- <br /> ---------------------------------------------`--------------------------------- --- <br /> ---------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and.+hat the work'will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. <br /> (Signed) 1 '--' =----- ------------------------------------------------------------------------------ <br /> -•_ ---------------{Owner and/or Contractor) <br /> r <br /> By:---v •----------------------------------------------------------- --- - - -- ---1� Title _ i <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------ ----- --- j <br /> IEWEDBY-•------------------------------------------------------------------------------------------------------------------------ DATE_ <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------- <br /> ---------- DATE ---- -------------------------- <br /> ---- <br /> Alterations and/or recommendations_________________________________________ <br /> ------------------------------------ <br /> - - - <br /> PERM17 No ISSUED-------- J / <br /> ---------------(Date) FINAL INSPECTION BY:---------------------____--_-- <br /> ------------ <br /> ------------ <br /> Date------------------- .� <br /> ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> E5--9-2M 4-50 W=1b34 <br />