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' APPLICATION FOR SANITATION PERMIT " / 3 2- <br /> (Complete <br /> (Complete in Duplicate) <br /> gp[ica+ion 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----------�ZO -- 4 <br /> ----------(5 -1/--J <br /> Owner's Name--------------------)��lhr. -A j-------------------------------------------------------------------------------- -- -------- Phone----------------- ---------------- <br /> Address----------�Z---__ -,/,/------e----- ------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> Contractor's Name-----------------49 ------------------------------------------------------------------------------------------ -------- Phone---------" '`~'� <br /> Installation will serve: Residence p Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />= Number of living units: Number of bedrooms 1;4— Number of baths m Lot size----------�_ _ _______�__-_f__ __ ______________ <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 Eg Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> - <br /> Septic Tank: Distance from nearest well--- -1-----Distance from foundation-------------------_Material----------------------------------------------- <br /> _ <br /> No. of compartments--------------------------Ca ----Size-------.-------;4i ,---•--------Liquid depth------------------------- <br /> Cesspool. Distance from nearest well________________Di ance from foundation---------;--____-__.Lining material___________________-__-----_-__--:__. <br /> ❑ Size: Diameter--------------------------------------Depth--------------------- "- ------------------------- � <br /> -;a a <br /> Privy: Distance from nearest well_______________________________________________Distance from nearest building------------------------------------------ <br /> FJDistance to nearest lot line------------------------------------------------ 46 <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____//W__-Distance from foundation___` __-___Distance to nearest lot line................. <br /> eac <br /> ne <br /> Number <br /> of filter material_I! "`"o2� �G""Depthof <br /> hffilter,mlaterial_--/ -------------- <br /> ----- <br /> �___,_-"Width of trench________ ��"" _______, <br /> Type ` <br /> j "Remodeling and/or repairing- (describe):--�------.-----t [cfi�Mt_______.__ /X11. ----�-�1.-. ------ -------- <br /> ------ <br /> r ------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify +hat I have prepared this application and that +he 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 /> 1 ----t .41----- <br /> (Signed) -------------------------------------(Owner and/or ar Contractor) <br /> ------ ----- <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 /> APPLICATION ACCEPTED BY------------------- --------------------------------------- DATE-------6--- ----�� --------- <br /> -- �--��J <br /> REVIEWEDBY----------------------------------------------- ---- --------------------- --- --- ------------------------ DATE--------------------- ----------------- ----------------- ., <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------- --------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:-----------------------------------------------------------------------------•------------------------------------------------------------------------------- <br /> --------- ---------------------------------------------------------------------------- --------------------------------------------- ---------------------------------------------------------------------------------- <br /> ' ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------- -------------------------------------------------------- -------------------------------------------------------------------------- <br /> PERMIT No--- a-'------- ISSUED----- /— -- ---- FINAL INSPECTION BY:-:------ --- [ -------- ------------------------------ <br /> Date------------------------ - --- � --`-a)7------ <br /> ( <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> 50 W-1639 <br />