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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 /> s <br /> JOB ADDRESS AND LOCATION--------- ------------------------- ---------------------------------- <br /> -------------------------- <br /> ---- -------------- Phone------------------------------------ <br /> Owners Name---------- _ ��3.ih37�t311i�---------------------------------- � <br /> Address---_2 4 50 E . -Flora----------------------------------------------------------------------------------------------------------------------------------------------------------------------- , <br /> Contractor's Name----------------------Dej_t a_------------------------------------------------------------------------------------------------------- Phone-----3-`-25955------------ <br /> 0 <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ `Motel ❑ Other ❑ <br /> Number of living units: E3. Number of bedrooms E2 Number of baths ❑ Lot size--------1QQ--.X---104--------------------------- <br /> Water Supply: Public system Ej Community system ❑ Private ❑ <br /> Loam Clay Adobe [& Hardpan ❑ <br /> I Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ❑ Clay ❑ Y ❑ <br /> l - <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------------------------------------------------- n, <br /> 1' gk-i6t ing No. of compartments--------------------------Capacity-------------------- Size Liquid depth <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 /> ❑ Distance to nearest lot line------------------------------------------------ <br /> Seepage Pit: Distance to nearest well______________________Distance from foundation------------------- to nearest lot line__._____ _ _ <br /> - <br /> Number of pits-----1--------------Lining material------bbrio-k--Size: Diameter__3_�a«!'�`'!O�Depth__---- --- - 1--- <br /> Disposal Field: Distance from nearest well____-----___-Distance from foundation'%o/.....--Distance to nearest lot line----------------- <br /> ® Number of lines___________1--------------------Length of each line-------�6pp*5_Q1,Width of trench____-aRp......22 <br /> -2...-------- <br /> Type of filter material___-___�'QQk------Depth of filter material________-_____- <br /> Remodeling and/or repairing (describe) r_epa1rlri�:`-------------------------------------------------------------------------- ---------------------------- <br /> ✓ , <br /> ---------------------------------------------—-------------------------------------------------------- <br /> ------------------ <br /> ----------------------------------------- <br /> ----------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 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)_..... Delta p I-PtSem"/fie_/�"`'�: ------------------------------------------------(Owner and/or Contractor) <br /> By----------------1.er-r-y---Wartharn__Jnr =--- ---------... ---�.�---------(Title)-------OwneryMgr•---------------------------- <br /> [Plot plans, showing size of lot, location of system in laVdin/ wells, buildings, etc., must be filed with this application). <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------✓ <br /> DATE----- <br /> ---- / /---------------------------- <br /> REVIEWED BY------------•---------------------------------- ---------------------------------------------------------_------------ DATE---------------�------ <br /> BUILDINGPERMIT ISSUED-------------------------- •--- -------------------------------------- DATE-------------------------------------------------------------- <br /> Alterationsand/or recommendations--------------------- ------------------------------------------------------------------------------------------------•---------------------- <br /> i <br /> ------ •------- <br /> ••--• <br /> -------------------------------------•----------- ------ ;------------------------------------------------------ <br /> -• <br /> ---•------- -•----•---------•----•--•----------------•---------------------- <br /> - e i <br /> + ------ <br /> 155UED{ = / -7 .-(Date) FINAL INSPECTION BY:_--.------- ------1 ------------------------------ <br /> PERMIT No. _ ._____ ✓ fj <br /> Date--------------------- -------•--------------• -•---- <br /> N SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES--9-2M 9-50 W=1639 ` <br />