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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 /> JOBADDRESS AND LOCATION-------&-00-_jf-------- ---`--------------------------------------------------------------------------------------- <br /> Owner's Name------1� -----------�&- --- ----------------------------------------- -------------- Phone94���--------- <br /> -- - - - ---- -------------- --- <br /> ---� �p--� - -------------------------•------------------------------- <br /> Contractor's Name--------------- 1---------- 1�`tort-0--------------------------------------------------------------------------- Phone----------------------------------- <br /> t installation will serve: Residence ❑ Apartment House ❑ Commercial 'R Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -[-I Number of bedrooms ❑ Number of baths ❑ Lo} size_____ __ _ _�_Q_-__-:____,_ ---- <br /> _ <br /> Water Supply: Public system;E, Community system E-1 Private W! , <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑O <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permittecl'if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---S-D!---Distance from foundation______.5�1_.---.Material------CBP. --------------- <br /> --- -- - - -. .Liquid depth -----------------No. of compartments--------t-------------Capacity----- O-------SizeaC . <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material__________________--_-_-_-___--____. <br /> �► <br /> ❑ Size: Diameter------•-------------=-----------------Depth---------------------------------------------------- l <br /> �IvPrivy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> -------------------- ' <br /> r _ -___Distance from foundation to nearest lot line_______-__---____ <br /> Seepage Pit: Distance to nearest well_______________ <br /> QNumber of pits_________ __________Lining material-----------------------Size: Diameter------------------------Dept h--------------------------------- <br /> ea <br /> _-_-______-__ _ _ <br /> e�;-�-r <br /> Disposal Field: Distance from nearest well_ .1`,6____-Distance from foundation______' _____Distance to nearest lot line_ <br /> [� Number of lines__________ _ __ -_Length of each line________ _ Width of french--------;'--_____________________ <br /> Type of filter material_I'J -- A_d_MKDepth of filter material___:____! <br /> Remodeling and/or repairing (describe)------------------ - - I ----- ---------------------------------------------------- <br /> ----------------------------•-------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- <br /> hereby cart' y hat I have-prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat la s, and rules nd' re ions of the San Joaquin Local Health District. <br /> 5i ned . ---- ---------------------(Owner and/or Contractor) <br /> ( g . )------------- -1 <br /> $y=-------------------------------------------------------------- ----------------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYW - - DATE------ -----L 7------ <br /> REVIEWEDBY------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------=------ ------------------------ ----------=----------------------- •---------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - <br /> --------------------------------------------------------------------------•------------------------------------------------------------------------------••--•---------•-------------------------•-------------------------- <br /> ------------------------------------------------------------------------------------------------------------------ <br /> i -------- - - - --- ------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------- <br /> ISSUED---1�~ = ------__(Date) FINAL INSPECTION BY:--- `=" <br /> PERMIT No-___.d v� - <br /> Date----------------- --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> s. Stockton, California <br /> 1 E5-9-2M 9-50 W=1639 <br />