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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> and install the work herein described. <br /> Application is hereby made to the San Joaquin Local Health Dlsloc for a permit to construct <br /> This application is made in compliance with County O d <br /> 9. <br /> ----A-0-------------------------------------------------- <br /> JOB ADDRESS AND LOCA�TION________aB_�-1. �*�---- PV �� <br /> �• -- � � -'--- ► - -- <br /> Phone <br /> , , 1.Owner's Name---------- � ----- <br /> P,ddress------------Ij--- ---Ly --- ------ <br /> -Contractor's s Name___________ ___ <br /> --------------- - --------------------- ---------------------------------------------------- <br /> Motel Other ❑ <br /> Installation will serve: Residence ® Apartment House El Commercial ❑ Trailer Court [je ❑ <br /> Number of living units: '�] Number of bedrooms �- Number of baths Lot size______ 1-l_ - - <br /> ---------------- <br /> I- <br /> Water Supply: Public systehhm ❑ Community,system ❑ Private ❑ <br /> Character of soil to a deptR of 3 feet- Sand F] Gravel [I Sandy Loam F-1ClayLoam ❑ Clay ❑ Adobe Hardpan ❑ <br /> TYPE OF INSTALLATION ND SPECIFICATIONS? sewer is available within 200 feet.) <br /> (No septic tank or cesspool permitted if public <br /> Septic Tank: DistancI� from nearest well-----------------Distance from foundation-------------------Material---Liquid depth__-________---__-__ <br /> ❑ No. of:l`ompartments------------------------- Capacity---- ------------------ <br /> Size-------------------------------- q <br /> �Cesspool: Distance from nearest well-________-____ Distance from foundation_________________-Lining materia__________-_______-- <br /> ---------- <br /> In Size: Dliameter------------------------ <br /> Depth <br /> Distance from nearest building_____----------------- <br /> ------------- <br /> Privy: Distance from nearest well----------------------------------- <br /> .1I <br /> ❑ _ <br /> Distance to nearest lot ine------------------------------------------------ <br /> El <br /> ___________________----------------- ----- - _ <br /> Seepage Pit: Distance to nearest well_____________________Distance from foundation__-____-___-____--.Distance to nearest lot line_______________._ <br /> ❑ it <br /> Size: Diameter ------Depth -r,.,.. <br /> Number of pits---------------- ----Lining material_____------ <br /> Disposal Field: Distant�e from nearest well___ ✓'Distance from foundation____-_-I-__-___Distance to nearest lot line__----/------- <br /> Number of lines--------- _- ----------- Length of each line-__:____--�__� ---------Width of trench____________ ----:------- <br /> h <br /> 4 __ <br /> �- } fl�c�Depth of filter mater�al------s"�_- _:_____- <br /> Type of filter material__��--- ---------- <br /> �1 --�C _}- - _ J---------------------------------------------- <br /> --------- --- <br /> Remodeling and/or repairing [describe]_____________________ _ - ------------­_ <br /> --------------------- ------------------ <br /> ----------- --------------------------------------- <br /> ------------ ----------------------- <br /> _II ------------------------------------------------------------------------------------------------------ <br /> I hereby certify I have red hi ;Pplication d hat the work will be done in accordance with San Joaquinos�n y_ordinances, State la , a d r .aiS"' reula#if the a Local Health District. ____.__Owner and/or Contractor) <br /> ------------------ <br /> (Signed)--------------------- J <br /> Title <br /> - - <br /> ---------------------------------------------------------------- <br /> By---------- - <br /> (Plot plans, showing size 4 lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> DATE------- /--------------------- <br /> APPLICATION ACCEPTED BY-------- - - DATE_. _./, _"�1- -------------------- -- <br /> REVIEWED BY-------- �k- ------1�c1__,t�-�-- -.--------------------- - -------- ---------------- DATE _ji --- - -- <br /> ------------- <br /> BUILDING PERMIT ISSUED------ -------------- ----------- ------------------------------------- -- a —t _ ---- ---- <br /> Q � ------------------- <br /> Alterations and/or recommendation-� k` -"�___ � P ---------- <br /> ��f <br /> - ------------------------- <br /> ----- ----------------------------- <br /> ----------------------------------- f -------------------------------------------------------------------------------------------------------------------------------- <br /> ------ <br /> --------------------------------------------------------- <br /> l <br /> -------------------------------------- <br /> - ---- - - DateFINAL INSPECTION BY:-------- --------- ---------- <br /> PERMIT No.__3_° ISSUED-------- ._ ---- -� 7 <br /> .-.- M -____. <br /> Date---------------------- <br /> I A <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W--1839 <br /> . I _ <br />