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.�y <br /> APPLICATION FOR SANITATION PERMIT 797 <br /> (Complete in Duplicate) <br /> Application is hereb made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------,7-1--7--------- tiff d Z.r 4�1� t @f <br /> Owner's <br /> OCATION------7-1--7---------- <br /> Owner's Name-------- J. y------------------- Phone------------------------------------ <br /> ------- ------- ---- ----------------------- <br /> Address---------------------------7:;-"?-----) Ale...... --- ------------------------------------------------------- <br /> 0--p- , -)-------- --- -------- <br /> Contractor's Name--------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence E] Apartment House,x Commercial E] Trailer Court [3 Motel E] Other [] <br /> Number of living units: ZF Number of bedrooms Kr Number of baths e- Lot size------ --------------------------- <br /> Water Supply: Public system � Community system F-1 Private F-1 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam'o Clay Loam E] Clay El Adobe 0 Hardpan E] <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_________________Distance from foundation--------------------Material------------------------------------------- <br /> F-1 No. of compartments--------------------- ----Capacity-----------------------Size--------------------------------Liquid depth-------------------------- <br /> 'Cesspool: Distance from nearest well________-_______Distance from foundation------------------- Lining material__-________________________________ <br /> ElSize. Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____________________-___.____-_________. <br /> Distance to nearest lot line________________________________________________ <br /> Seepage <br /> ine------------------------------------------------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ <br /> F1 Number of pits----------------------Lining material-----------------------Size: Diamefer------------------------Depth--------------------------------- <br /> ,..Disposal Field; Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of lines----------------------------- ----Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material-------------------------Depth of filter material-___________ <br /> a .79-4, <br /> le):----- -------------W,-- <br /> -Remodeli g and/or repairing {describe]:----5.. Ae----------e-,y I j?------- <br /> - - ------ -- <br /> ----------- <br /> ---------- ------------ X <br /> -------------------------------------------------------------------------------------------------------- ------------- - ---------------------------------------- <br /> I <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. 'ate laws, and rules an4 regulations of the San Joaquin Local Health District. Z <br /> (Signed)--- ----e------ ------------ -------1-6 --------------------------------(Owner and/or Contractor) <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 /> FO DEPARTMENT USE ONLY <br /> All Z <br /> APPLICATION ACCEPTED BY--- —---—------------------- DATE------y/1-_;p__-K/ <br /> REVIEWEDBY--------------------------------------------- -------------------- ----------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED------------------ --------------------------------- ----- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:--------------------------------------------- ----------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- <br /> ----------------------------------------------------------------- ----—----------I----------------------------------------------------------------------------------------------------------------- <br /> PERMIT No.YXI---- ISSUED----- S---_ -1-(Date) FINAL INSPECTION BY:-----------(Al---V -------------------------- <br /> Date------------------------ <br /> fT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9.50 W=1639 <br />