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` ""IAPPLICATION FOR SANITATION PERMIT <br /> v [Complete in Duplicate] <br /> a <br /> l Thpslappl�ation es madeadein ctompl ante with gClountyaOHealthdDi�oc549r a permit to construct and install the work herein described. <br /> -------------------------------- <br /> JOB ADDRESS AND LOCATION-------------�.,�rZ�- -- ------ ,- ----------------------------------------------------------------------------- <br /> Owner's <br /> --- <br /> ��rr --- Phone_�� ___ <br /> Owners Name -------------- -----------------v7, �--�o/� ls�E - -------- <br /> Address----------------------------------- -------------------M7g ----------------------------------------------------------------------------•- <br /> : a <br /> Contractor's Name------------------------------- �NA_I_ Li-!l_" _1.0se-------------------------------- Phone ?7794 _a7-------- <br /> Installation will serve: Residence % Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: [t Number of bedrooms IVNumber of baths jj�' Lot size___ ------- -________-______-` <br /> Water Supply:I : Public system 01 Community system F-1 Private E] &*MUQ,9A1 SYPA-" �tCst1-4 <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_OOK41__Distance from foundation----/0-----------Material-----------------------------------I----------- <br /> No. <br /> _ _No. of compartments--___;�----------------Capacity:_T_�'____b_"------Size)~'SJa`A_46r1iquid depth_A�l__•�x__'1---------- <br /> Cesspool: <br /> _______ � <br /> C p --------------------Lining material_------------------------- I <br /> ess ool: Distance from nearest well_________________Distance from foundation <br /> li❑ Size: Diameter_-----------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well__________________________ ____________ __Distance from nearest building________________________________-__-_--_ <br /> p g Distance to nearest lot line----------------------- ----------------------- <br /> Seepage <br /> ___________________ <br /> See a e Pit: Distance to <br /> nearest well-- ___ ma <br /> fr m f u a on_�Q_________.Dist�cetonearestiotline__ ___ <br /> --- - - ---- --- ------ <br /> P 9 l ---- ize: Diameter___,0�-----------Depth-- --•------•- <br /> .Disposal Field: Distance from nearest well_4*0____.Dis+a oundafion____10_.______Distance to nearest lot line____���.__-_ <br /> Number-of�ines.- - -__ . ___.;_.Leingth_ofMeach..line__T Q_'___ __.Width,of trench-_--- --------- <br /> ------------ <br /> ------=.Y- - <br /> } - �r - {: <br /> Type of filter material___/_� _�_____,Depth of filter1material_ <br /> _Remodeling and./or- repairing (describe):------�Lw-----���%1kA�-1QrV-------------------------------------------------------------------------------------- <br /> ----------------------------------------------------=---------------------------------------------------------------------------------------------------------------------------------------------_-------------------- <br /> ------------------------------ --------------------------=------------------------------------------------------------------ -------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County, <br /> ordinances, State I s, rules and regal ns of the San Joaquin Local Health District. <br /> Si ned-------- <br /> By: <br /> __-- _ •- _-- -- Contractor <br /> BY:----------- ------------------------------------------------- <br /> -1 <br /> ------------------------------------------------ {Title <br /> (Plat plans, showi r� _*------------- ------------ <br /> size of lot, locat n of system in relation to wells, buildings, a+c., mus+ be ed with this application). <br /> a <br /> FOR DEPARTMENT USE ONLY' <br /> APPLICATION ACCEPTED'-BY------- - ' ------------ ----------- _ DATE---- —&---7. -A /` ----------------------- <br /> REVIEWED <br /> ---------------------- <br /> REVIEWEDBY---- ---------------------------------•-------------•---------------------------------- ---- ---------------------------- DATE--------------------------------------- <br /> � <br /> , -�` ------------ <br /> / ------ ----- -f�=------ -------------- <br /> ---------------- <br /> DPERMIT-ISSUED ------ -__- -- - DATE <br /> -------------- <br /> Alterations and/or - � - ---:_--------- <br /> ------------------------ -- ------- --------------------------- <br /> U "`f _ --- <br /> - ,�----� - p --- - <br /> --------------------------------------------------------------__________ ______________---------_--------------------.__________________________________.________.____________________ _____r___________--________________ <br /> PERMIT NoV_«----- ISSUED_______ ___ ___________(Date) FINAL INSPECTION BY: <br /> Date-------------/_�"-"/.ST'—S,-/ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />