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APPLICATION FOR SANITATION PERMIT <br /> i (Complete in Duplicate) <br /> - 4J^ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct acid install the work'herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_,r2--/1--z__-___-�."---"_ ' ----------------------------------------------------------------- <br /> - ----------:-------------------- <br /> ar Ar <br /> --- <br /> Owner's Name_____ - <br /> t <br /> -- - ---- ---------- --------- -------- -------- -------- -------- - Phone---------------------- <br /> ► Address---- �� �~,---- <br /> Contractor's Name----- <br /> - <br /> '------------------- -------------------------- Phone__ "� Q <br /> Installation will serve: Residence ------��- ""- -"- <br /> Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ {Other p <br /> Number of living units: Number of bedrooms Number of baths V1 Lot size_---_-_XiP*------- _ -------------------- <br /> Supply: <br /> Water Public system Community system ❑ Private ❑ � f <br /> f <br /> Character of soil to a depth of 3 feet: Sand ❑ JGravel ❑ Sandy Loam ❑ ClayLClay {� <br /> oam ❑ y ❑ Adobe Hardpan ❑� t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �+ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> (� V <br /> Septic Tank: Distance from nearest well_"-__---_--____-Distance from foundation__________________".MaterialEl _-__----_ -___- <br /> ------. --- V_� <br /> No. of compartments ­­CapacityLiquid depth-------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_____--------__-_-_ <br /> ❑ Size: Diameter---------------------------------------Depth------- --------- --------- - - - -- ---- <br /> rivy: Distance from nearest well---------------------- --- <br /> _ _----__"-------------Distance from nearest building <br /> Distance to nearest lot line--_______�-:__--_-__ <br /> ---------------------------- <br /> Seepage Pit: Distance to nearest weil_-7-�"-------Distance fro foundation_" <br /> Number of pits----- � '' -�e7-"-----.Distance to nearest lot line__--____--_"_".-- <br /> ----------Lining material---_�.'vt----- ' <br /> I Size: Diameter__„ . __ ----___.Depth-- -O �__ ___ <br /> ..Disposal Field: Distance from nearest well -� -- i <br /> p Distance from foundation-_- .- ---_ Distance to nearest lot line--__,�Q-'__- <br /> --- <br /> - Number of lines_____----------j--_ ------------Length of each line"---___ � � +� <br /> -------- <br /> Type of filter material__- __-- "-_- -----------Width of trench__.--__ _ /__"---------_ <br /> Yp I Depth of filter material__"-- --------- <br /> '-Remodeling and/or repairingscribe):----"---------------- <br /> ----------- <br /> ' <br /> ----- --------- <br /> --- ---------- mac- .- <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, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed}-.•-- -�- � <br /> -"'!"--" ------ ------(O�.and/or Contractor) <br /> I 'OL------- Title"--- <br /> ( ) _�----------------- <br /> (Plot plans, s owing 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-------------------------- <br /> -- DATE- <br /> REVIEVVED BY e <br /> - -- -------- DATE <br /> BUILDING PERMIT ISSUED--------------------------- -- ----- ------------------- <br /> -------- "---�------- - --- - -------- - ------�--- DATE------------------------- <br /> -- --------- <br /> A ------------------- <br /> Alterations and/or recommendations:--__I_---""-______ -------•---------------------------- <br /> -------------------------- <br /> ------------------------------ <br /> ----------------------------- <br /> ------- <br /> ---------------------- <br /> ----------------------------------------------------------- <br /> = ---------------------=----------------- <br /> -- - - - ----- <br /> - - - <br /> - -- <br /> PERMIT N�•4-'17_----- ISSUED---T� <br /> �-_f <br /> ---- - - --/ -�--�---___--(Date) FINAL INSPECTION BY:-_,----�.-�_" ---_ .- <br /> i ---------------- <br /> Date----------------- <br /> -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT { <br /> 130 South American Street <br /> ES--9�2M 9-50 W:1639 - Stockton, California <br />