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APPLICATION FOR SANITATION PERMIT 35 3 <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 here/ye 7Pue'd� <br /> This application is made in compliance with County Ordinance No. 549 <br /> JOB ADDRESS AND LOCATiON­,,-- <br /> co <br /> Owner's Name.--­ --- - --------- -------------- <br /> --------- --------- <br /> --------------- ----------- --------------------------- k <br /> Address----!2-4,?---4 e ---------------------------------------- Phone-___ - --- <br /> 3_._N--- f,--�----------- <br /> --------------- <br /> ------- -- ----------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name­ <br /> Insfallaf ---------:------ --------­- ------------------------------------------- Phone--- <br /> !on will serve: Residence C) Apartment House-0Number %--Z <br /> Number of living units: E] Number of bedrooms E] Commercial E] Trailer Court A-".Mofel F] Other C] <br /> of baths C1 Lot size <br /> Wafer Supply: Public system CommunifY system El Private ------ -------)(­.-?--4?-- ---------------------- <br /> Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam F] Clay Loam 0 >\ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Clay . AdobeX Hardpan [] <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--_______________Distance from foundation------­----------Material <br /> El No. Of compartments_______--_ <br /> ---------------oCapacity­--------------------Sz. <br /> Cesspool: Distance from nearest well i 0-------------------------­—Liquid depth-----­------------------ <br /> ❑ Size. Diameter____________­-- ------Distance from foundation___________________.Lining material <br /> Privy: Distance from nearest well__________________--------_Depth---------------------------------------------------- <br /> El Distance to nearest lot line______________________-------------------------------Distance from nearest building-_------_-----_------------------------ <br /> ......... .... .. .... <br /> Seepage pit: Distance to nearest well---- -_--Distance­from_m foundation____ <br /> Number of pits__.___-_____________ 9.1 --!!5� --------Distance to nearest lot line <br /> Lining maferial-4 424U,� Diameter___-F—?�-----------Depth--- <br /> _Size. <br /> -Z <br /> Disposal Field: Distance from nearest well-________________Distance from foundation________-______--__�Disfance to nearest ]of rin�e -"�: <br /> El Number of lines_______________ Length of each line ----------- <br /> jIfer material______________of f' ---­--­---------Depth of filter Width of trench_______-______ <br /> and/or repairing (describe): <br /> ­-­----------- <br /> -------------------------------------------------­­------------------------------ ---------------------­----------------------------I­------------------I-------1----- <br /> ----------------------------------- <br /> ---------------- <br /> ----------------------------­-­---------------------------------------------------------------------- --------------­-­------- ------­--------­ ---------­------­ <br /> ------------------------- --------------------------------------- f. <br /> ------------------------------------------------------------------------------------------------------------------------------------- ------­----------­ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin''Cou-n-ty <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> -- <br /> ............. <br /> By: -------------------------------------------------- jGWMT"ffffd7'�br Co tor] <br /> ---n-1 ---------------------------------------------------------------(Title)-- --------------- <br /> (Plot plans, showing size of lot, location ofsystemin relkon to wells, buildings, etc., must be file'-d-----with---f-h-is-ap-plication). <br /> FOR DEPARTMENT USE ONLY <br /> .APPLICATION ACCEPTED <br /> ABUlfBY <br /> - <br /> --------------------REVIEWED BY,------- ----------------------- ----------------------- DATE - 7 <br /> -- <br /> -------------ILDING PERMIT ISSUED-------------- ---------- ­ DATE v— <br /> ------------ <br /> ----------------- ----------- <br /> ---------­ <br /> dgra+ions and/or-recommencaf! ........................... DATE ........... <br /> ---------------------------------- -----------I-------­----- -----------------­--------­------------------- <br /> ---------------­-----­--------------------------------------------------------------------------- --------------------­--------------------------------------- <br /> -------------­-------I------------------------ — <br /> --------­-----­------­------­----------­------------------ <br /> -------­-­---- ------------------------- ---------------------------------------------­--------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------­------- -------------------------­- -------------------------------------------------------­--------­----- <br /> PERMIT No.----- ----- ISSUED__./-)---7 -J-�) - <br /> --------------------------------------------------------*--------------------------- <br /> --- ----­-------------------------(Date) FINAL INSPECTION BY: -------- ------------ <br /> Date <br /> ­--------­--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ES-9-2M 9-SO W-1639 Stockton, California <br />