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'�- ' of <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health Dist ricf for a.permit to construct and install the work herein described. <br /> This application is made in compliance with Cou�nttyfOrdinance No. 549_y <br /> JOB ADDRESS AN LOCATION--- `&T ------/V_�_"�," __S-?--- �_--OC.- 0 � T ---------------------------w --------------- <br /> Owners Name------ ` -A- -'------8-& 's-------------------------------------------------------------------------------------- P <br /> Address------------------------- S* ------------------------------------= Y-- <br /> ---------- <br /> Contractor's Name----- '` --------------------------------------- -------- - --- Phone-----=------------------------- <br /> - ------------- <br /> Installation will serve: Residence ®s Ap rfinent House Commercial ❑ Trailer Court ❑ Mot I ❑ Other ❑ <br /> r <br /> Number of living units: -❑l Num er of bedrooms Number of baths [1 of size------ _ 1 _ �------_____________________ - <br /> Water Supply: Public system Od Com unity system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: and ❑ Gravel Sandy Loam ❑ Clay oam ❑ Cay obe [� Hardpan ❑ . <br /> I il <br /> TYPE OF INSTALLATION AND SPECI [CATIONS: <br /> 1 (No septic tank or cesspool permi ed if public sew r is available within 200 feet.) <br /> Sep is Tank: Distance from nearest well_-__a__ _-__-_-- istance from oun afion____ --------------Material ----_---d_- a <br /> No. of compartments__________ ":________CapacitY___ 8 '4 '91. --r _ __R13---------Liquid depth________�_Q_-_-_ <br /> Ce sp ol: Distance <br /> is a Diameter <br /> well-----------------Depth <br /> Dii tance from foundation--------------------Lining material_____________________________________- <br /> i ❑ p <br /> Privy: Distance from nearest well_________________________________________ ____ Distance from nearest building------------------------------------------- <br /> b <br /> Distance to nearest lot line_____________________________________________ <br /> Seepage Pit: Distance to nearest well________________ �f dation_________---------Disfance to nearest lot line______.-________ <br /> _____Distance from. o n <br /> ❑ Number of pits----------------------Lining material-------------- -------Size: Diameter------------------------Depth--------------------------------- <br /> IP <br /> -----------_-----_-------__-. <br /> It <br /> Di pa al Field: Distance from nearest well�_4__ bisfance from;foundaticn___fQ` _----Distance-.to-nearest lot line___ <br /> Number of lines-------______4-------------------Length of each line------�flI-____________-Width of-trench______- _i_ _--__________ <br /> Type of filter material9 �r10(_Depth of filter material---------- <br /> r ' <br /> Remodeling and/or repairing (describe):----------------------------------------------------------- --------------------------------------------------------------------------------------------- <br /> ---------------------------------•--------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------- <br /> ------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- d <br /> -------------------------------------------------------------- ---------------------- <br /> 1 hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules andregulationsof the San Joaquin Local Health District. <br /> FI�(�i�/� __ Owner and/or Contractor <br /> x - - - ------------------------------------------------------------------ <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> x i <br /> - FOR DEPARTMENT USE ONLY ' <br /> APPLICATIONACCEPTED BY------------------------------------ ----- -- -------------- -----=---------------- DATE-------- <br /> REVIEWEDBY---------------------------------------------------------- - - - - ------------------------------------------------- DATE-------- ----------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------- <br /> Alterationsand/or recommendations:-----------------------------------------------------------------------------------------•----------------------- ------------------------------------ <br /> --------------------------------------------------`----------------------------------------------------------=--------•-------------------------------------------------------------------------------------------------- <br /> --------------------•---------------------------------------------------------------------------------- --------- - <br /> d1��� =---(Date) FINAL INSPECTION- BY----------------L'LI--v -----— - <br /> PERMIT No._ ____ ___ _ __ [-SSUED::_____- __-:- _ � _ <br /> - -- --- ----- <br /> rt <br /> .� -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South-(Arnerican Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />