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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin al Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with o Ordinance No. 549. <br /> ------csil�--- --------------------- <br /> JOB ADDRESS AN OC ION__ 41 ----------- - ------- -------------- <br /> Phone------------------------------------ <br /> Owner's Name-------;W&---- ----- _J---- ----------- <br /> Address---------+-I__r�>-- ------------------------- ----------------------------)----------------------------------------------------------- --------------------------------------------------------------- <br /> Contractor's Name--- -------- -----------------------------------------------------------­-------------- - --------- ------------------------------------ Phone----------------------------------- <br /> Residence Apartment House Ej Commercial L] Trailer Court Ej Motel Ej " OtherEl <br /> Installation will serve: <br /> Number of living units: [Community <br /> umber of bedrooms Z Number of baths QD Lot ---0-------------------------------- <br /> Water Supply: Public system system El Private El <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam �e/clay Loam 0 Clay E] Adobe E] Hardpan E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ", iptic ,Wank: Distance from nearest well ------Distance fry founclatior____, /_0-----materi I_-__---------------j---------- ----------- <br /> -4Kg --- <br /> No. of compartments------------- ------------Capacity- _0------Si,,___L. <br /> 3 x. -Liquid depth------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----------I---------Lining material-_-------------_____------------ --_. <br /> ❑ <br /> aterial------- ---------------------- ------- <br /> ElSize: Diameter--------------------------------------Depf h---------------------------------------------------- <br /> 'Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ <br /> 171 Distance to nearest lot line-__-___---------------------------------------- <br /> Seepage <br /> ine------------------------------------------------ <br /> Seepage Pit. Distance to nearest well-I-------------------Eisf ce from foundation--------------------Distance to nearest lot line----------------- <br /> D Number of pits----------------------Lining material-----------------------Size: Diameter------------ -----.Depth------------------------- <br /> vDispo4 Field.:,,.Distance from nearest-well Distance4rcrmLfounclatic 11 413,---------------- <br /> Number of lines----------- - -A ------Width of trend - - --------------- <br /> Type of filter matei, Length of each line------- - I <br /> Depth of filter material----------- ---------- <br /> Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------- --------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------- <br /> I---------------------------------------------------------------------------------------------------------------- -----------------------------------I---------------------------------------------------------------- <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, and rules and regulations of the San Joaquin Local Health District. <br /> (Signedp,00 ----------------------------------------(Owner and/or Contractor) <br /> ........... -------�11 ------------------------------------------------------------- <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 /> APPLICATIONACCEPTED BY-------------------- -41 ---- ---------------------------------------------------------------- DATE-- ---------------------------------------------------- <br /> ---- ---- DATE--- <br /> REVIEWEDBY----------------------------------------- -------- ------ ------ rX11-------------------------------------------- <br /> --------- ------------------------------------------ <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE --- <br /> - - <br /> Alterationsand/or recommendations:----------------------------------------------- ------------------------------------------------------------------------------------------------------- <br /> r--------- <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------�;� <br /> --------------------------------------------------------------------------------- - -------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -----------------------: ---------------------------- ---- --- ----- ------------------------ --I----------------------------------------------------------------------------------------------------------- <br /> PERMIT --- ISSUED---- ------(Date)- FINAL INSPECTION BY:-- - ---- ----- --------- --- -------- <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 />