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APPLICATION FOR ?ANITATION 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 Ord�inaante No. 549. I <br /> JOBADDRESS AND LOCATION____-----��_7_{----------wfs-�-----9---------------------------------------------------------------------------------------------------- <br /> Owner's Name-----;%*C-------7`�JC3-N --------=--f--------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Address------------------------- - --- --- ---------------------------------------------------------------------------------------------------------------------------- I <br /> Contractor's Name----- ----- --- ------ ` - -- - ------ ---------------------------------------------------------- Phone----------------------------------- <br /> -installation Trailer Court Motel Other <br /> .Installation will serve: esidence Apartmen.- ouse ❑ ❑ ❑ ❑ ❑ <br /> 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 ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) n <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------_Material_•________-__-__________________._____________. V� <br /> ❑ No. of compartments----------=---------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- <br /> Cessp I: tante from nearest well-----------------Distance from foundation__-----..-______-_.Lining material____,_______------_._____--.---____._ <br /> Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Ivy: Distance from nearest well-------------------------------------------------Distance from nearest building_______.__.___________________-_---------. <br /> ❑ Distance to nearest [of 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 /> ...Disposal Field: Distance from nearest well------------------ from found ation--------------------Distance to nearest lot line-------- _-____- <br /> r ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench_____________-----________________ <br /> Type of filter material-------------------------Depth of filter material____:____--__-_------- <br /> Remodeling and/or repairing (describe):___________________ ___A41_?------ ---------- - <br /> h - ---------------------2------------------------------------------------------------------------------- <br /> ------------------------------------------- /---- ---- ------------------------------------Mail/--------- --- - --- <br /> -----------------------------------------------------------------------------------------•------------ <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 regulations of the San Joaquin Local Health District. <br /> (Signed)---- _ly ----------------------------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> J <br /> BY:--------------------------------------------- -- ------------------------------ --------------------- - -------------_-.(Title)---------------- ---- - ------------------------------------ <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 /> APPLICATIONACCEPTED BY---------------------- --------------------------------------------------------- DATE----------- - <br /> REVIEWEDBY----------------------------------------------- -------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------- -------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:________________ "� <br /> ----- - ----- -- <br /> ------------------ F. _7 <br /> -- ----------- <br /> -`; ---------------- " -� <br /> ------------------------------r--�--�---------------------------------------------------------------------------------- -- -------- -- -- ------------------_-- <br /> --------------------------------------------------------------------------------- ---------------------------------------------------------------------------- -- - <br /> ' PERMIT No._�'�____ff------ ISSUED--. '-1- -` -_--(Date) FINAL INSPECTION BY---------------------------------------- - - <br /> Date-------------------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> F Stockton, California <br /> —2M 9-50 W-1639 <br />