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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 64 W eS <br /> ---------------------------------------------- <br /> Owner's Name----- S V '------------------------------------------------------------------------------------------- Phone------------------------------------ <br />,, Address S-4.1V '-----------------------------------------------------------------------•----------------------------------------- <br /> l i 7Contractor's Name---------- ------------- Z,7_j_d <br /> t E Installation will serve: Residence P Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ' Number of living units: I Number of bedrooms [I Number of baths Z Lot size___�01---7S"--------------------------------- <br /> Water Supply: Public system Community system F-1Private ❑ O i <br /> Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan <br /> p ❑ ❑ Y ❑ Y ❑ Y ❑ ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Liquid <br /> _T <br /> Septic Tank: Distance from nearest well--------------_ Distance from foundation___-___-6_t-----4vaterial----C__oN6 __- / <br /> -, <br /> ------------ <br /> ANo. of compartments---------- -----------Capacity------�Aa----- -Size----3-4'Fx- .----L-q 'd depth------ ---------------- <br /> Cesspool: <br /> _ ----------- <br /> , <br /> Cesspool: Distance from nearest well-----------------Distance from foundation________________-_.,Lining material__-----___________________--_________. <br /> ❑ Size. Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> F1 Distance to nearest lot line------------------------------------------------ <br /> Seepage <br /> ________________________ ____________________Seepage Pit: Distance to nearest well----------- e—----Distance from foundation-----0.0------ Distance to nearest lot line ------- <br /> Number of pits---------/'---------Lining material___`,lit G �-Size: Diameter---_._„�__�2________.Dept -------------------- <br /> -Disposal Field: Distance from nearest well_____ ___.Distance from foundation_--___/1 Distance to nearest lot line_________...__ 9 <br /> Number of lines------------/r____________________Length of each line________ /� <br /> g � _ Width of trench--------a'`f------------------- <br /> Type of filter materia jt_99! K--------Depth of filter material__-__� _______:__ <br /> Remodeling and/or repairing (describe)-------------------/► +l w--------- ------------------------------•-------•--------------------- <br /> ----------------------------------------------------------- ----------------------------------------------------------------------------I----------------------- -------------------------------------------------------- <br /> - -------------- ---- ------- ----------------------------------------------------------=-- ------------------------------------------------------------------------------------ <br /> I hereby cerci I have prepar is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St aws, d r es an a alations of the San Joaquin Local Health District. <br /> (Signed)---- ------- ---- -- ---------- @------- ------------------------------------------------(Ow er and or Contractor] <br /> j <br /> By: ------- -- ------- (Title) <br /> (Plot plans, showing size of lot, Iota ion of system in relation to wells, buildings, etc., must be filed with this application). <br /> 1 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------------- -------------- DATE-------------- <br /> - ---------- <br /> - <br /> ------------------- <br /> REVIEWEDBY------------------------------------------------------- -------- ------------------------- DATE------------------------------------------------- <br /> BUILDING <br /> ----------------------------------- ----- <br /> BUILDING PERMIT ISSUED.- ----- ----------------------------------------- DATE <br /> Alterations and/or recommendations---------------------------------- --------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------- i <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -----------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------ -Z___ <br /> --------- --- ------------ <br /> --------------------------- ----------------------------- -------- ---------------------------------------------------------------•----------------------- ----- -- <br /> - - -- -- - ----- --------------------- <br /> --------------------------- <br /> PERMIT No�-�.ii✓------ ISSUED______ ___l a / (Date) FINAL INSPECTION BY---------------- -- ---- - --- <br /> Date --- � ---------------- <br /> `/ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT if <br /> 130 South American Street <br /> Stockton, California �~ <br /> ES-9-2M 9-50 W-1639 <br />