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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County 0r d' nce No. 549. *, <br /> JOB ADDRESS AND LOCATION____Al__ :'-______ __----------------------- -----__ _ ______ <br /> - _ -------- ------------- ------------------------- ---- - - ------ <br /> Owner's Name------ e -- Phone �J1� <br /> - ------------ - - -------------- <br /> ----------------= ------==----------- - <br /> Address-.- <br /> ---------------------------e--�----------- <br /> Contractor's-Name---AA'--Q�1i__�' �'�'''''�------------ � ----- Phone__�":�-S�L_ 17 <br /> Installation will serve: Residence's Apartment House ❑ Commercial E] %Trailer Court ❑ Motel ❑ Other ❑ <br /> .S 11 Number of living units: Number of bedrooms Number of baths'[ Lot size__ °____ -____ ___________________ ________ <br /> Water Supply: Public system '❑ Community system ❑ Private <br /> Character of soil to a depth'of 3 feet: 'Sand ❑ Gravel ❑f Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe Hardpan 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: ',Distance from nearest well__J.P.-____Distance from foundation- faµP__ _____-Material----- <br /> . "_. V <br /> ° No. of compartments--------2--------------Capacity.---6°Q a_-----Size/!4?r_'-�!AL 8Liquid depth__ -".---------- <br /> Cesspool: <br /> _ __ __Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material________-------_-____________________- <br /> ❑ Size: Diameter----------------- --------------------Depth---------------------------------------------------- <br /> Privy: r- Distance from nearest well---------------- <br /> _--------------------------------Distance from nearest building-------------------- <br /> ❑ Disfance to nearest lot line________________________________________________ <br /> See e Pit: Distance to nearest wel!-----I_h_ ..-_Distance from foundation......cSO------Distance to nearest lot line_--- <br /> Number of pits-------,,...--------Lining material.__ --Size: Diameter_____,i`f------ <br /> _Depth-_____=V_Q__ _______________ R <br /> ----- <br /> Disposal Field: Distance from nearest well____10_-__-_Distance from foundation_____ __-_-__.Distance to nearest lot line____+ -_____ <br /> Number,of lines_____________I` ____,,_pp____��_ Length of each line_______S70__��--_____-Width of trench----- 4l_`�---------------- <br /> Type of filter maferiall�_X4----Depfh of filter material-----1,.2_---___:___ <br /> Remodeling and/or repairing (describe) =' =---------------------------------------------------------------------------------------•------------------------•---- -------------------- <br /> ---------------------------------------------------------•----------------------------------------------------------------------------------------------- <br /> ------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------•----------------------------------- <br /> I hereby certify that 1 have prepared this application and +hat 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 /> 5i ned s r <br /> (Signed) _(��d/or Contractor) <br /> ------------------- <br /> BY� --------------------------------------------------------------- -----(Title] --------------------------0 <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 /> APPLICATION ACCEPTED BY----------------- ------------------------------------------------ <br /> ------ - ---------------------------- DATE------ <br /> - --------- - -' <br /> REVIEWED BY------------------------------------------- ---------------- <br /> BUILDING <br /> ------------------------------------------------------------ DATE---------------- ------ <br /> BUILDING PERMIT ISSUED--------------------------------------------------•-------------------------------------------------- DATE s <br /> ---------------------------------------- <br /> Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------- = <br /> -----------------------------------•------------------------------------------•--------------------------------------------------- -------------------------------------------- ---------------------------------------------- <br /> •---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------- -------------------------------------------------------------------------------------------------------- -----------------------------------•----------------------. <br /> k, PERMIT No.�__6_________ ISSUED-___ -- ----------.-(Date) FINAL INSPECTION BY:______ ____-_�-{--------------------------------- <br /> Date-------- <br /> Date.-------- <br /> ----------------J---- -0------------------ <br /> { SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> �J' } 130 South American Street <br /> Stockton, California <br /> 5�4-2M 9.50 W=1639',,• <br />