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Po <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made +o 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. . 6,4 w <br /> JOB ADDRESS AND LOCATION-'------ riacl .as1 _ d__1'er hln --------------------- vy,F S-T-° ---P=R5o <br /> Owner's Name----•-------'L{.r €x' ' T--------------------------------------------------------------------------------------------------------------- Phone----&--' 53.'7------------- <br /> Address ------------------------ - _Qw -`Z-- - <br /> Contractor's Name---------- :.�?-,� 1C��3'B ------------------------------------------------------------------------------------------- Phone-----2---X90------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -[3 Number of bedrooms E3 Number of baths m Lot size------7Q;Xj:5(_)______________________________________ "4 <br /> Water Supply: Public system E& Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam.E] Gay ❑ Adobe ® Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank,or cesspool permitted if public <br /> cs/sewer-is•avai able within 200 feet.) <br /> Septic Tank: Distance from nearest well_______A_----_Distance from foundation-----1Q1-------Material._____{jDnCrete-_______________--. <br /> 0 No. of compartments---------- �-___..-_---,Capaccty----80Q--_______5izeZx,5-xg---------------- Liquid depth __._-.__-__ <br /> Cesspool: <br /> Distance from nearest well-----------------Distance from foundation--------------------Lining material______________________________--_____. <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> :Priv Distance from nearest well --------------------Distance from nearest building------------------------------------------- <br /> n Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well-------Q------------Distance from founda+ion_--__-�_O--------.Distance to nearest lot line-------lQ____ w <br /> �] Number of pits----------1---------Lining material-----Bri-ek__Size: Diameter____-_ 1 Depth_____-________________________!�' <br /> 4 t <br /> .Disposal Field: Distance from nearest well_______----------------- from foundation--------------------Distance to nearest lot line--------- �., <br /> Number of lines-----------------------------------Len Length of each line------------------------------ of trench____ _ ��-------------_-_-- �y <br /> i g .i - <br /> Type of filter material__/Li-_ °SLC_Depth of filter material______!__�L__ _______ }, <br /> Remodeling and/or repairing (describe):------------------------1> e_W_-HA.M�=--------------------------------------------------------------------------------------------------------- <br /> Y <br /> _____________________________________________________________________________________________________________________..___________.______.__.._______-._--_____________-_-___..________--_-___________________________________ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances, State-I wsranArc2 and regulations of the San Joaquin Local Health District. <br /> - ... <br /> (Signed) - ----- --------- --/G ------------------------------------------------------------------------------ -------(Owner and/or Contractor <br /> --------------------------------------------------- ---- (Title) � �.----------- <br /> - ----(Plot plans, showing size of lot, location of system in relation-to wells, buildings, etc., must be filed with this application). <br /> FOR-'DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___<?_____ __ ______ DATE__yr__ <br /> - - ------------------------------------------------------------------------- --------------------------------------------- <br /> REVIEWEDBY-------------- ---------------- -------------------------------------------------------------------------- DATE---- ------------------------------------ ------ <br /> BUILDING PERMIT ISSUED -------------------------------------------------------------------------- DATE------------QCN;--- - ---------------------------- <br /> Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------•---------------------•--------------------------------------------------------------------------------------------------------=----------------------------------------------------- <br /> ----------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- -------------- -- ----- <br /> r' <br /> L _______________________________i_______----__-----_---_...__----_-_._-__-..___---..-_________-___________________.--------------------------------------------------------___ _________--___---________________-_-__-_____ <br /> PI RMIT No------ _Pto---- ISSUED--_----L�-` -' -- -------(Date) FINAL INSPECTION BY----------------------- /`------------------------------ <br /> Date----------------------------- ll,%/all,%Z5-1------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Americari Street <br /> Stockton;'California <br /> ES-9-2M 9-50.W-1639 <br />