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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 /> JOB ADDRESS AND LOCATION---------------5331 cls �.1 Q�i�_._S -0-akton-------------------------------------------------------------------- <br /> .... <br /> Owner's Name------------------------- -----------•-------- • . W ,�.SQZl-- ------- --- - ---- ------------------------------ Phone !! 569 <br /> •s«�r 3 8' 6C.-11. AJ <br /> } <br /> Address------------_-------_-------------------------------- ----------------------------------- -------- -- -- <br /> Contractor's Name D• IRISH---SSC--S_QTS t - Phone6� y.. <br /> Installation will serve: Residence OMApartment House ❑ Commercial ❑ TrailerCourt ❑ Motel ❑ Other ❑ ri <br /> Number of living units: El Number of bedrooms Cr Number of baths [[],*Lot size--____65-1--_--_1C---__11Qt---------------­ <br /> Water <br /> ____________ _Water Supply: Public system ❑ Community system ❑ Private [I <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(Y Hardpan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' <br /> Qa y <br /> Srap#ic ank: Distance from nearest well_ ____J_ _-_Distance from foundation---_l_-------------Material_01,4------------------------ <br /> *2_,)-b <br /> -,-----"_'_-_--____--- <br /> -Z, I,_ IS-0 <br /> i .i No. of compartments_____________*4--_-_-_____Capacity__ --____, -_____Size_________________________Liquid depth___ _ _____ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------------------- <br /> Size: <br /> ____ -_--______________-__Size: Diameter---------------- -------------------Depth---------------------------------------------------- <br /> Privy: <br /> -------- --------- ------ ----- <br /> Privy: Distance from nearest well________________________________-______________Distance from nearest building-------------------------------------- <br /> El <br /> __-______-____________- _____- ___❑ Distance to nearest lot line------------------------------------------------ <br /> Seepage <br /> ____________________ ____________________Seepage Pit: Distance to nearest well_____ _______________Distance frpm foundation--------------------Distance to nearest lot line-------------- <br /> Number <br /> _______ ____Number of pits----------------------Lining material-----------------------Siiw Diameter-------------_----------Dep -----..__ ,__---- <br /> .Disposal Field: bistance from nearest well 1_ ___.Distance fr 1 Orine <br /> aticm �_ Distance to nearest lot line----- <br /> t <br /> _______- <br /> [� Number of lines_________.------- ------------Length offrea ____-_.__3_4t__ _ Width of trench-----2- -------------------- <br /> Type <br /> __________Type of filter material __-_1�____----------Depth of filter material __-___1$__........ <br /> -Remodeling and/or repairing (describe):-----------Installing__leach__drain-_.of_f____existing__-reaas trap-.�. <br /> C_onnsct g--__�_p-,r-_oa__-3Q_'---_sever---lina__fxom---lavatory to---g-ease---trapL « ------ <br /> -- <br /> - <br /> , w. , <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin <br /> ordinances, State laws, and rules and regulations of the"San Joaquin Local Health District.Inc - Confra`E! <br /> (signed) - • - Skln3i lilt-.- • <br /> B ----- - - ------------------- --- ------- ------------- ---------- -------------(riitle)<-----.Rst_imatQP.-•..---------------------- <br /> (Plot <br /> ---------- - ------ <br /> (Plot ns,, swing size of lot, location I system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------ _____ _ DATE------- <br /> �F �------------------------ <br /> REVIEWED BY------------------------------------------------ - <br /> --------- ------ - ----------------------------- DATE "� ------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------- -------------------------------------------------------------- DAIE_--------------------------------------------------------- <br /> Alterationsand/or recommendations------------------------------ -------------------•-------------------------------------------------------------------------------------- --- <br /> --------------------------------------- --------------------------------------------_----------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- ------------------------------------------------------- ---------------------------------------------------------------------------------- <br /> PERMIT No._(:k ___---_ ISSUED--------- ----3'_Y ,, "" --(Date) FINAL INSPECTION BY:_---__ _----! -'-------------------------------- <br /> Date-------------------- --�` -------------------=-----------=-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ' 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />