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L: d <br /> APPLICATION FOR SANITATION PERMIT , a 1 <br /> f (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. 5.�4c9. <br /> JOB ADDRESS AND LOCATION-------------------- ------ -- �4/e = - <br /> Owner's Name------------------------------------------------------------ 1--- ---•------ All ywey------ Phone T-_!�_ _G`- <br /> Address--------------------------------------------------------------`1#s-- -------- <br /> 6.4, dq G_fi:-------------------------------------------------------------------------------------------- <br /> Contractor's Name-------------------------------------- Phone--9=-0'-4(Q---------- <br /> Installation will serve: Residence)?�_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: [ Number of bedrooms 2KNumber of baths Z'� Lot size__ <br /> Water Supply: Public system Community system ❑ Private ❑ <br /> I . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe2< Hardpan ❑ � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ptic �,nkk:,� Distance from nearest well_________________Distance from foundation--------------------Material_________-__________________________._________- <br /> ' � C No. of compartments------------------=------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation-------------------- Lining material_ <br /> F ❑ Size: Diameter-------------------- -----Depth------------------------------------ ---- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> [] Distance to nearest lot line__ ___--------------_______________________ __ <br /> Se epa a Pit: Distance to nearest well a�r 'Uistance from foundation__/Q_f_____�Dcistance to nearest lot line___c7_r_ r <br /> Number of pits_________-/---------Lining material< _'I4____Size: Diameter_.o,.t,. ��____.Depth___ _ ________________ <br /> is�os Field: Distance from nearest well------— ---------Distance from foundation----------------- -__Distance to nearest lot <br /> Number of lines_____________e----------- ength. of each line_________�b � W' th of trench________2_;_________________ <br /> G Type of filter material__�f'_ '�e�epth of filter material______�d_-__ Nem ��rf ��/'�9 �h ) <br /> 'Remodeling and/or repairing (describe)______________ ______________ _- _ _ <br /> � �` ------------------------------------------------ <br /> �i.F�/t � .Qfs�r �- ----------------------------------------------------- <br /> ------- ---------------------- -_------------------------------------ -- ----------------------------- --------------------------------- <br /> ----- ----- ---- --- ------------------------------------------------------------------------------ ----- <br /> I hereby certify t I have pr6pared tis application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law d rules and' re ations of San Jquin Isocal Health District. <br /> (Signed} 1 31MAIT <br /> - ------------- Contractor) <br /> = ' = ----------------(Title -- --- nQ�,Lfi/�� -_---------------------- <br /> (P of plans, sho Ing of to , ocation of system in lation to wells, buildings, etc., must 6VTtled with this application}. <br /> t FOR DEPARTMENT USE ONLY <br /> s APPLICATION ACCEPTED BY---------- --- _11----�---------------- ---------------------------------------- DATE----- _Q' tS� -1--------- <br /> REVIEWED BY-------------------------------------------------------------------------------- --------------------------------------------• DATE--------------------------------------------------------- <br /> .. <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------- - -- - <br /> Alterationsand/or recommendations------------------------------------------------ --------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------- -----------------•------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.- <br /> ----------------- ------------------------------------------- a ---------------------------------------------------- <br /> Date <br /> ----------------- <br /> �/ ad J <br /> PERMIT No��`�___�__ ISSUED__________ ________ �_._�____{Date] FINAL INSPECTION BY:_______ � <br /> ------ --- - -------------------------------- <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 />