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e <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> 6. <br /> Application is hei4by made to the San Joaquin Local Health District for a permit to construct and,it theiwork-44iein described. <br /> This application ismade in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--------------_- P�It�T Agp - 4'.0 � <br /> Owner's Name.. .-----• 10to..-go fl _ •- -•-- ------ Phone.1_e_RI ---- <br /> Address O E htt 8 Ay e Stockton <br /> --- <br /> ----- ................... , <br /> Contractor's Name, a R_.. ` 1sh.-$c t if & Phone:: - `.. <br /> Installation will serve: Residence ►] Apartment House ❑ Commercial ❑ Trailer Court '(]' Motel ❑ Other ❑ <br /> Number of`living units: Number of bedrooms(,�i Number of baths Q Lot size_.___.._., .__ __ � <br /> WaterSupply: Public system rj Community system fn,%, ivate ] <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam Clay❑ 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................__..Material__ ______ _ _____ter---------- <br /> ❑ No. of compartments------ ----------------Capacity-• ----------------Size-------- -------• --• Liquid depth•-'�..................... <br /> Cesspool: Distance from nearest well a_:-----_._Distance from foundation_________________Taming material::.. -_____, -_ ----- <br /> ❑ thSize: Diameter-•------------------------------------Ds <br /> ---- ------- <br /> p <br /> Privy: Distance from nearest well---____-- ---..--- ---------- --•• ---.Distance from nearest building- ------- ---------_______-_-- �. <br /> ❑ Distance to nearest lot line <br /> See age Pit: Distance,to nearest weI .5.1_.____,Distbnce from gni -lo`n rnce to newestlot I t �� <br /> Number of pits �R! �lmaterial Att._ Size: Diameter---=� DepA---- <br /> n .. ........ ..... <br /> Disposal Field: Distance from nearest ell � - .Distance from foundati ! <br /> p . . yv � __ !1-2! <br /> _... Distance #o nearest bt line ��Number of lines___ VIi Length of each line :.. th pf,#rerchT e of filter matenal __ ' De th of'filter'materna__ i� <br /> YP P --_--_----- <br /> `'Remodeling, iUon to exillltft drs1Aage sys� <br /> Remodelin and/or repairing. describe --__.... .._.........Y---- -------- - -------- --------- _-------- <br /> - ------•-------------------------- ------ ------- -----+----- ----- - ----- - - > w <br /> --- • •. -- ------- •---•- •--•-- -•--- <br /> - <br /> ;. •--- --------- `---'•. ---••-•-- ------:---a---------1-•------------ -——- -------- --------- ----------"`i --— - --- — <br /> {Y- prepared application � Counf+jt ' a <br /> ordinances,. ae1ewsh andh uVe nd regulations of the San Joheum Lccall Health District. <br /> dmaeeVwith San Joe uin <br /> ---- <br /> (Signed) z -- �{ - - �cZ&O/or Contradoq <br /> • - ---------- Title President <br /> (Plot plans,sh ing size of lot, location of system in, elaFion`tyr-wells, buildings, ,etc',- musi�be filed with Ail application). <br /> FOR--DEPARTMENT USE-ONLY k <br /> APPLICATION ACCEPTED BY __....... <br /> ---- ------ • --•--• DATE....— <br /> REVIEWED BY---------------•......•.............--- ------ ------------------------- ----- --------------------- <br /> -------- DATA <br /> ------ <br /> BUILDING PERMIT ISSUED---------------------------- ------------------------------ -------•---- _----- DATE - - - <br /> Alterations'and/or recommendations-------------------------------------------------------------- -------- -................................. <br /> -- <br /> ��✓ D {sac res { s = ' 'al <br /> -- <br /> - <br /> ------------­- -.__ .._. ______________ .._._... _........................................... -- <br /> PERMIT No._ i' s...... ISSUED.-_. ...__.__...(Date) FINAL INSPECTION BY:......I/X).......--------- ---------.................... <br /> yDate O <br /> ...: ......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-4—M 9-50 W=l639 <br />