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I APPLICATION FOR SANITATION PERMIT r3 , <br /> (Complete in Duplica+e) <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 Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--------------8 __�_:.__� 'Cl._3. aa__-Stk'n., Calif-. <br /> Owner's Name--------Mra-F------Alma--Ar-Chamb_ault------------------------ Phone -6298 <br /> ------------------------ -- <br /> - - ------------ <br /> ----------- <br /> Address------- -�---+�-�----�-a.Y'�1Ha.i---�:�r_���.�-a-------------------- - <br /> - ------- --------------------------------------­­------- <br /> Contractor's Name---•:Delt _.. _�.� ------------------------- <br /> --------------------------- '��l�� <br />'r -------------------------------------- Phone---nstallation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> 9 ❑ bedrooms Z] -Number of baths [I Lot size---1QQ__X__3Q0_________________________________ <br /> Number of living units: • Number of <br /> Water Supply: Public system ❑ Community system ❑ Private <br /> Character of soil to a depth of 3 feet: Sand ElGravel ElSandy Loam E] Clay Loam ❑ Clay El Adobe ® Hardpan ❑ <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---5Q_-------Distance from foundation___.—1 Material____ eMell,--____ ,__ ' <br /> ------------- <br /> No. of compartments------------2-----------Capacity-----goo---------Size----.gx4x4-------------Liquid depth------------ - <br /> Cesspool: Distance from nearest well_________________Distance from foundation----_______________.Lining material_______ _______"_________------------ <br /> ----------------------- <br /> Privy."- <br /> - <br /> ---- <br /> El Size: Diameter Depth -- <br /> Privy: " Distance from nearest wella____-_______________________ <br /> __ -__=._____Distance fiom nearest building <br /> ❑ � Distance to nearest lot line__________ '_"'«-_-� <br /> Seepage Pit: Distance to nearest well--------------_-------Distance from foundation---------------------Distance to nearest lot line___`:_---------- <br /> ❑ Number of pits----------------------Lining material---------!, _____---Size: Diameter__...---------•--__-_--.Depth------ <br /> -_ <br /> --- <br /> Disposal Field: Distance from nearest well"______ Q_.....Distance�from foundation________:._____ _-Distance to nearest lot lineI _�-____.__ <br /> ® Number of lines---------____l-------------------Length of-each line_______�t l.... Width of trench_____ <br /> p a <br /> Type of filter material-----Z' ck_______De th of filter maferial__-____�.$___- _ <br /> Remodeling and/or repairing <br /> b s? 1 - (describe)-----------------Ingt_ai latiQn---(neve-14-01A.- <br /> --------- <br /> neve-1 -01A.-------------------------- 8Ystel---exi a jm&-- <br /> an&_ta------- <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 regulation of the San Joaquin Local Health District. <br /> {Signed}--•--•--------4iz <br /> 1 � ae.-------------------------- ----------------------(Owner and/or Contractor) <br /> By (Title)---------:-Qwner!?Xgr.-----------------"------(Plot plans, s I oca+ion system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. ---------------------- - DATE_-------/2 h <br /> REVIEWED BY ------------------------ <br /> ---------------------I---------------------------------------------- DATE---- --1L`_I_'"__S-za <br /> BUILDING PERMIT ISSUED---------------------------------=--------------------------- -------------------------------- <br /> DATE ------------ <br /> Alterations and/or recommendationscY_____---__ <br /> ---------------------------------------------------- <br /> }. <br /> --------------------------------------- -' <br /> ------------------ ---------------------------------------------------------------I-------------- ---------- <br /> - <br /> ---------------- <br /> --------------------------- <br /> rc ~' <br /> PERMIT No:_/ --------- _-- ISSUED---_-'42-✓��--5 ----------S--•---(Date) FINAL INSPECTION .BY:_- <br /> Date ----------- ------ i <br /> 4+' r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ES-4-2M 9-50 W=1639 Stockton, California I <br /> i <br />