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f 7s_. <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> a <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> f This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND QeATION__..__..-....... --!_____�_- t <br /> Owner's Name_. <br /> ......, cr�_ _� ____!.� f� Phone_ <br /> --------------- <br /> Address---- <br /> Contractor's <br /> -------Address---_Contractor's Name----------------------------------------....... ---------------------------------------------•--------------- Phone----------------------------------- <br /> Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 0 Number of bedrooms [f Number of baths Zf Lot size------------J_a__ _. �_4G___________________ <br /> .r <br /> Water Supply: Public system [g Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay W Adobe❑ Hardpan ❑ <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 1/0 Material_____- �.YClJva I______-_-- <br /> [� No. of compartments____________ _ ________Capacity__ 1 _m�__ _ 5ize __ s?_ _Liquid depth________`7`"_-____----- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___________________________________- 4 . <br /> ❑ Size: Diameter-------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line________________________________________-______ <br /> Seepage Pit: Distance to nearest well-_____ _______________Distance from foundation------------.-------Distance to nearest lot line----------------- <br /> El Number of pits______________________Lining material._-..------------------Size: Diameter------------------------Depth________________..______.�- <br /> Dispos Field: Distance from nearest well-----------------_Distance from foundation______-__I_______-Distance to nearest lot line__-_--___._.___ <br /> Number of lines_____________ �____________Length of each line_________Sa--___�---_-Width of trench_______________________ <br /> Type of filter material_ 4_& '-1t7epth of filter material_______.�g____._._ <br /> Remodeling and/or repairing (describe):----------- µ--`---- -.. 9----------'------ --x--S-------- a-- ----•-- ------------------- <br /> ---------------••---•---•--------------------------------------------------------------- ---------------- ----- ° ------------- --------- ---- -------------------- <br /> --•--------------- -------------------•--•----•------------------------------ (A-a P 4, <br /> = � . <br /> 1 -- <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)-------- -=------- = ------------- ------'---------------------------------------------- ---- ---------(Owner and/or 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 /> " <br /> FOR DEPARTMENT USE ONLY ! <br /> APPLICATION ACCEPTED BY____________________ DATE__________ �,o___ <br /> ------------ --------------------------------- <br /> REVIEWEDBY------------------------------------------------ ---- -- ---- -- --------------------------------- DATE. ----- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------ r <br /> Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------- -------------- <br /> ----•---------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------•--.--------------------------------------------------------------------------------------------------•----------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------------- ------------------------------------ ---- <br /> PERMIT No.-4_7.5_________ ISSUED_______ I _ _ ._!-____----(Date) FINAL INSPECTION BY: r. - ____1 r? <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> E5-9-2M 9-50 W-1639 <br />