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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> altiri District for a permit to construct and install the work herein described. <br /> A,ppl'lc6fi on is hereby made to The San Joaquin Local Her <br /> with County Ordinance No. 549. I"*—L)l <br /> This application is made in compliance -------------- ----------------------------------------------- <br /> t9, �f_-. -i k Ajj k " <br /> ---------------- ---- -------------------- --------- <br /> alk Phone-? <br /> JOB ADDRESS AND LOCATION_ ----------i ---- -- ------------ <br /> 4� K <br /> ----------------------------- ­1� - --,, T_�___ _ - 4 C <br /> Owner's Name_____________ ------- i--- --------7--- .0 <br /> Y73---------------------- Phone------------------------------------ <br /> Address------------- --------------------------------------------------- <br /> Contractor's Name-----•-----•--------------------------------------------------------- Commercial 0 . Trailer Court 0 Motel 0 6ther <br /> Residence ff Apartment House 0 Com �_ -1-_T:r------ -------------- <br /> Installation will serve: Number of-bedrooms of baths V Lot size----------------- ---- <br />.--.i,.-,— 'Nurnber of living units: C3 Community system 0 Private ❑0 Adobe 0 Hardpan U <br /> Water supply: Public system 171 Sandy Loam [I Clay Loam 0 Clay Ad <br /> Sari <br /> Sand Character of soil to a depth of 3 feet: Sa'd C] Gravel ❑F1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet-) <br /> (No septic tank or cesspool permitted if public sewer is av -------------------Material--------------------------------------- <br /> Disfa'nce from I nearest well-----------------Distance from foundation ----------_Liquid depth__----------------------- <br /> Septic Tank: .A.; -------------------Size--------------------- <br /> No., of compartments--------------------------Capacity----, _Lining material------------------------------------- <br /> 0 ol: Distance from nearest well------------I----Distance from foundation--------------- <br /> Cesspo ...........Depth---------------------------------------------------nearest building <br /> 0 Size: Diameter--------------------------- Distance from ----------------------------------------- <br /> nearestwell______------------------------------------------- <br /> Privy: Distance from4" <br /> - ------ ----- <br /> Distance to nearest lot line--------------------------------e-f-rom--foundation_____4�0--------- to nearest lot line — - <br /> ❑ <br /> 0 Distance to nearest well__-_2-7#--------Distanc Size: Diameter----��6-------------Depth- -------- ---------- <br /> _t� - ­!_�.. -. <br /> Seepage Pit: material----------------------- <br /> Number of pits-______e_/_----------Lining r _ - -Distance to nearest lot line-------------- <br /> E� - st,�n- --------:------- <br /> D;stanto_JrP�n�gd-� t�kel� ---- DI Ed- ---Width of trench----------------------------------- <br /> 15 pp -Length <br /> =:;:-D SPI Field� of each line_-------------------------- <br /> Number of lines----------------- of filter material----------------------- <br /> ❑ <br /> Type of filter material____-____-"-___----------Depth ---------------- <br /> ------------1---------------------------------------------------------I--------------------------------------------- --------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------------------ -------------------------------- <br /> ----------------------- <br /> --------------------- - <br /> -------- <br /> -- <br /> ------------------------------------------------------------------------------------------------- ------------------------------- <br /> ---------- -------- --- ---- ------------------- _. <br /> -----------------------------I--------------------------------------------------------------------------------------------------------------------------------in accordance with San Joaquin County <br /> I hereby certify that I have <br /> --------------------------------------------------------- <br /> prepared this application and that the work will be done e San Joaquin Local Health District. <br /> ordinances, and rules and regulations of the --------------(Owner and/or Contractor) <br /> per Tn <br /> inances. State laws, <br /> (Signed) ------------ ----------------------------Title( ,-----------------------------------•--------- <br /> ------------------- ------------------------------------------- <br /> By:--------------------------------------------------------------rn--i-in--relation- t-o wells,-buildings, etc., must be filed with this application). <br /> size of lot. location of system I (Plot plans, showing FOR DEPARTMENT USE ONLY <br /> ------------------- ------ ------- ------------------------ ----------------------- <br /> APPL-IC-AT-I(DN-�-ACC-EPTED�'BY=-------- -- ------ DATE-----------------------------------------------I------------ <br /> ------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> REVIEWED By----------------------------------- ---------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ --------I-------------------- <br /> ---------------------------------------------------------------------------- --------------------- <br /> Alteraiiont and/or recommendations------------------- --------- -----'" <br /> ecommendations:------------------------------------- -----------------------------I---------I--------------------------------------------------- <br /> ­--------------------------------------------------------------------------- -------------------------------I------------------------------------------------------------ ------- <br /> ----------------- ------------------------------------------ ----------------------------------------------- <br /> ----------I----------------­­-----------------------------------I-------------------------------------------------------------------------------------------------- ------------------------- <br /> ----------------------- ------------------------- I-------------------------------- ---------- <br /> ----------------------- -- ---------------------------------------------------- -- ------------ <br /> -------I---------------- --------4E --------------(Datel FINAL INSPECTION BY:. <br /> PERMIT No Date-------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> rc-9-2M 9-50 W-1639 <br />