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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__7_ �_____r <br /> - -( _ <br /> x------ - {ate 01 <br /> Owners Name---_-__-- Phone---A--_1--7_-&------:-- , <br /> r ----- ------ ---------------------------------------------------------------- <br /> Address---------------------1`� � -----�7......14-9 �� /�------------------------ -----------------------------------•----------------- ------------- ------------- <br /> Contractor's Name �_ �__I'�.�ZRl_5�� ¢ � � n ----------------------------------------------------- Phone-----�'_-R_S_T-7= <br /> Installation will serve: Residence ❑ Apartment House ❑ ,..Commercial ❑ Trailer Court ❑ Motel ❑ Other 54 e4b117 <br /> Number of living units: [f Number of bedrooms [Z Number of baths ® Lot size_____._.._r?_^___?-------Yy o_'-_____________________ <br /> Water Supply: Public system ❑ Community system ❑ Private i <br /> Character of soil to a depth of 3 fee+: Sand Gravel Sand Loam Clay Lam Clay Adobe Hardpan. p ❑ ❑ v ❑ v ❑ v ❑ � p ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank orcesspool permitted if public sewer is available within 200 feet.) <br /> 4 . I .— . <br /> Septic Tank: Distance from nearest we11__! _O Distance from foundation---1_ ---------.Material`tt_ _FC'___ �-_ll _. <br /> K No. of compartments-------'L------------Capacit ----------Liquid'depth__�-Z"------------. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.------------------------------------- <br /> El Size: Diameter--------------------------------------Depth--------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building <br /> ❑ Distance;to nearest lot line------------------------------------------------ <br /> -Seepage Pit: Distance to nearest well--- Q'--------Distance from foundation___-��*_-___g"_.Distance to nearest lot line__/a_�_____ <br /> Number ofpits--------/-----------Lining materiole__ __"- Size: Diameter_ `Q_"---------Qepth,--_ -'_------ _ <br /> _Xisposal Field:-- Distance from nearest well-44e__-____.Distance from foundation__.' �-------- <br /> -_- Distance to nearest lot line--Z-4--------- <br /> Number <br /> _____Number of lines--------------- _______________-_Length of each line____��p-'_..---------Width of trench_�_".__________________ <br /> Type of filter materialL�__�_ t----Depth of filter material----lQ2"_--___,___ <br /> Remodeling and/or repairing (describe):------ •-_ - -- ---------/------------------ ------------------- --_---- <br /> ------------------------------------------------------ -----------------••-----------------••-•-----------------------------------------••---------------------------------------------------•---------------------------- <br /> f � <br /> _______________________________________________________________________•__________________________--___---____________-_---_____-___._____________________-_•________________-___-_--____----____________._.._-.-___.________ <br /> I hereby certify that I have prepared this.application and +hat 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.<77 ` <br /> (Signed)- + ':lA��Rj;LX ` -------- S, ------------------------------------------(Oftm-+ Contractor) <br /> ------- -----------------=--.-=----------- ---------------------(T --�. <br /> {Plot plans, sktng size of lot, location of syste in relation to wells, buildings, etc., must be filed with this application). <br /> t FOR DEPARTM NT USE ONLY <br /> APPLICATION ACCEPTED BY - ------ --- DATE------------ <br /> ------- <br /> BY------------------------------------------------------- ----- ------------------------------------ DATE.----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------•------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:--------------•------------------------------- -------------------------------------------•---------------•--•------------------------------------------------ <br /> ----------------------------------------------•----------------------------------------------------------------------------------------------------_....-._..------- -------------------------------------------------------------.-- <br /> t <br /> ------•------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- ---------------- <br /> PERMIT No._.___�K j57---------- ISSUED------ --------{Date) FINAL INSPECTION BY:----- .-`- - -----y --------- ______r_�3----------------- <br /> Date------------ _&--6 I----------------------------•------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />