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_ a►Z <br /> 3�. <br /> APPLICATION FOR SANITATION PERMIT <br /> j 1 0 (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 /> JOB ADDRESS 2A ) LOCATION---lst �{------------- ------- ' =----_-------------------------------------.------------------------------------------ <br /> Owner's Name._ ¢ , . <br /> ----__--------------------- Phone------. <br /> c <br /> Address-----U l--q------- - - (` -----------------------------------------•------------------------------ --- <br /> Contractor's Name.._ A � G `J '` Phone__�!ngP_. 1� <br /> Installation will serve: Residence Apartment House I-] Commercial E] Trailer Court ❑ Motel 171Other E] <br /> Number of living units: Ep Number of bedrooms 00�1 Number of baths 0 Lot size. .... .�_., ------f-.-R"S.................... <br /> Water Supply: Public system ❑ Community system ❑ Private k <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan L�f <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------------------­---------- <br /> ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth._.. ....... ------- <br /> Cesspool: <br /> ---•-Cesspool: Distance from nearest well-------------•_--Distance from foundation-_•__------.__--___.Lining.material"----___--.-__--_-__-__--___"__-_:_1:. <br /> ❑ Size: Diameter......................................Depth--------------------------------------------------- <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ <br /> ElDistance to nearest lot line...._//-_-•_-------•--_-"---__-•--_"-_---.---_-_ <br /> Seepa _.a Pit: Distance to nearest well_____� .._Distance from foundation---2-a------Distance to nearest lot lin .. <br /> 0_1 Number of pits___.______-______._Lining �2 <br /> -------- <br /> material_.�'`y^! Size: Diameter____.3�__.____._._.Depth______.�.5_ ________________ <br /> Disposal Field: Distance from nearest well ..............Distance from foundation--------------------Distance to nearest lot line <br /> Number of lines--- --------- Length of each line........... -r Width of trench __._._ ------------------- <br /> Type <br /> �-_ _.._._-. <br /> Type of filter material_______°_ ! ._Depth of filter material-___--.-/� ..._._ <br /> Remodeling and/or repairing (describe):......................................................................................................................................................... <br /> -----------------------------------------------------------------"---•----------------------------------------•------------------------------------------------------------------------------------------------ <br /> ---------------------•-----------------------------------._...._._..._---•--__...----•-----.._...._...----._..--•-----••._..__._.._...------•--•--.._-•••----------•-••••-•--._.___.--•-..__.-------••-----•-- <br /> --------------------•------------------------------------------------------------------------------ -------------------------------------------------------------------------------------•-----------•--•------• ------ <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 /> Olt- <br /> (Signed)- -------• ------ ----------------- -•------"-"---'-----------------•-------------•-----------------------•-------- --- -� �/or Contractor) O� <br /> By:------ z .��____�- - - -----------------------------------------------------""-(Title)--- F ----------------------------- <br /> (Plot <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------------_- c%'`~ ------------------------------- DATE.-•--------- ----- ---- <br /> REVIEWED BY �-`-.'----- . "' ---------- -----------------------------_ DATE--"---.-- - <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE.- •-----------------••------- <br /> Alterations and/or recommendations:"--"----""""------------------------ ,----------------------------------------------------------------------------71------------------•-------------- <br /> �off�L <br /> -sem g .�-., .-e ' --; 1 e.�' <br /> ----------'-"'�^-� K 1�' 2--"`--------- - - ...................... <br /> PERMIT No.-.2-_.3.7_........ ISSUED------- ---'`?� <br /> ----------(Date) FINAL INSPECTION BY:------------1N__Y_--- <br /> - ­------------------------­ <br /> Date...................U <br /> -----.----_-----------Date-"--"------"-------U '!-•- 11 ..... --"-"" <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W<1639 <br />