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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 /> 5/ Z D - - <br /> -- <br /> JOB ADDRESS AND LOCATION------------------------------------�2-D,E_L[_---' --------S--T-------------------�-T N <br /> Owner's Name--.......W_!---1 S Od ------------------------------------------------------------------------------------------------- Phone----------------------------•------ <br /> Address-----------------------�----'Z-= ........ _2 -------------------------- r----------------------------------------------------------------------------------------------------- <br /> Contractor's Name------------------#+)3 CJ L) ------ Phone----------------------------------- <br /> ------ <br /> Installation will serve: Residence K, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 'M Number of bedrooms 2, Number of baths d Lot size......_-------------47?;�_x__l.ocd_-___--_--_---_ <br /> Water Supply: Public system ❑ Community system ❑ Privatex <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.___t0---------Material---------121,0-i_-1-I___- _ __-_- <br /> No. of compartments-_-___-___�---------Capacity....Z -------- ---------Liquid depth____-_'S'�_-_0 -- __. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation____--------------- Lining material-----------------------.-------------- <br /> 171 <br /> --._- __❑ Size: Diameter-------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-.-_--:_-_.-____---_______________-_-__. <br /> ❑ Distance to nearest lot line___--_•_________________________________________ <br /> Seepage Pit: iDistance to nearest well----------------------Distance from foundation....................Distance to nearest lot line,---------------- <br /> 1771 Number of pits----------------__Lining material-----------------------Size: Diameter------ =J___________.Depth................................. <br /> ..Disposal Field: Distance from nearest well___��...Distance from foundation----- Q_ 70--___-6istance to nearest lot line-- ✓----- <br /> Number of lines___________ __ ~ <br /> �'— __...__Length of each line_---:---__fov______________'Width of trench________ `/�__`!__._____-___- <br /> ___________ __ <br /> Type of filter material_.. Depth of filter material---------/Z.N_____ <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 donein accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-------- -- -+,- ----------------- -----------------------------------------------------------------(Owner and/or Contractor) <br /> B .- ---4--e ---------------------- ------------------------------------- -(Title)--- ------------------- ----------------------- --------- <br /> (Plot plans, howing size of lot o on of em in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ ----------------------------------------------------- DATE--------...L1 ;-----/_/_ -r;_f ..--------- <br /> REVIEWED BY. ---- -- ---- ------------ -------------------------- DATE---- ---- ---------- ----- -------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------------------_-----------------..... DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------- ------------------- <br /> ----------------- --------------------­-----------------------------------------------------------------------------------------------------------...............................------------------------------------- <br /> ---------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ , <br /> PERMIT No. AL ISSUED___.-7 /�s �_______._._(Date) FINAL INSPECTION BY:__.. . __ ____..,_ <br /> ba+e ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />