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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 Ordinance No. 549. - <br /> JOB ADDRESS AND LOCATION----- M--- _bot i---fide---Q ___��l ar__R�adi----1r_�=--Mile--------- <br /> we$t of Hi W�.yY 9North. . oser Phone--- �---------------- <br /> Owner's Name---------------------------------------- - - - - - ----------------------------------------------- <br /> Address 206 Faroe r'3--_9 Me rjrh&-nt_I_�''_3ank---B-UUd1ag,---L0.d1--------------------------- <br /> D. A. P-arri.e-h & Sons,.__lnCg---------q---------------- ------ Phone---9--96Q7------------- <br /> Contractor's Name------------------------------- - --- ---• •------ ---- <br /> Installation will serve: Residence [Z Apartment-I-louse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:ZI ,Number of bedrooms'?] Number of baths M Lot size---30Ve_r-a.1.___AcrP.a_(A-yew---- <br /> Water Supply: Public system ❑ Community system ❑ Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN 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-_50_1-----_Distance--from-foundationlf3 _____ Material_____G___(',_--Brl-ck____________--- <br /> -.co 80 0 Gal 8�' �: til <br /> �,.m-»--�►�-"r`""^:..`_- No. of compartments---------� -----------CapacitY------------- -------Size_'.----�DX��k-------Liquid depth-----�--- --------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------ <br /> Size: <br /> material_______________________-___________ <br /> [] Size: Diameter------------------------- ------------Depth---------------------------------------------------- <br /> Privy- Distance from nearest well_________:_______________________________-_---_Distance from nearest building________ __.______________________ __.-� <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> `Seepage Pit: Distance to nearest well----;M___-------Distance from foundation__10__----------Distance to nearest lot line__--____________ <br /> Number of pits----;L---------------Lining material--jQ---Ci BZJ.911;�: Diameter-----3-3-;1-----------.Depth------Z0--------------------- <br /> .,- -Disposal Field: _ _Distance.from nearestawelL________________-D.istance from_foundation---.----------------Distance to nearesf,lot-line____--_,______...g <br /> ❑ Number of I-snes-----------------------------------Length of each line------------------------------Width of french---_---------------------------�-- <br /> Type of filter material-------------------------Depth of filter material________-_----_-______ <br /> Remodeling and/or repairing (describe):---------RepJacing---exi._st-1nF,__.yra.t-ejA;-------Hard--PAIN__Ar-ea.L,_•----------------- <br /> --------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------- ------------- ---------------- ------------------------------ ------------------------------------------ -------- --- ---------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St s, and rules reg tions . e San Joaquin Local Health District. <br /> (Signed)_ . PA a =-----------------------------------------t-------------- '-----{��XContractor) <br /> •--- ---- <br /> SON <br /> location.of s- stem in relat� Title Etir3atox' <br /> BY: �' `== ( ) - t---=---'------- ---------------------------------- <br /> (Plot_pla s,.showin siz of-lot, _ r y _to_wells, buildings,-etc.,_must,be.fil_ed with this app lication). <br /> FOR DEPARTMENT USE ONLY <br /> i <br /> APPLICATION ACCEPTED BY------------------------------------- ---------------------------------------- DATE---------------�-­j-j ------- <br /> REVIEWED BY--------------------------------------- --------------- ---------------------------------------- ------------- DATE----------------------------------------- --- --------.. <br /> ------------------------ - <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ DATE <br /> Alterationsand/or recommendations---------------------------------- ----------------------------------------------------------------•---------------------------------------------------------- <br /> ------------------• ----------------------------------------•-------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------•--------------------------------- ---------------------------------------------•- ----- <br /> --- - -------------------- - --------------------------- --- ---------------------------------------------------------------------------------------------------- - <br /> ------------------ <br /> PERMIT No._. --- ISSUED------- --- - -----(Date) FINAL INSPECTION BY:--- _--- <br /> ----- -- ---- ------- <br /> Date <br /> -- <br /> Date- `' ------------------------------- <br /> SAN <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />