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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby-made-fo.fhe San Joaquin.Local-Healtk,D.isfrict.-for.a permi-f-to-construct-and-install-f.he-y4,ork herein,�describecl.__ <br /> This application is made in compliance. with County Ordinance N449. <br /> X7- ------------------------ __ <br /> Owner's-1 ------ <br /> -- ------------- <br /> JOB ADDRESS AND� <br /> O,CA <br /> ----------------------------- <br /> w—ner,'s,-1_N Name- ------------)CS1------------ ---------- --- -- - ------ ------ Ph( <br /> Address ---- - --- ---------- <br /> -------------S-Y-0--cletoAl---------------------------- <br /> �1-7_ <br /> Contractor's Name------_-_-- --------P/q ------------- Phone__- ��5; --- <br /> Installation will serve: Residence Apartment House E] Commercial Ej Trlaiier Court [] Motel 0 Other ❑ <br /> Number of living units: -VI Number of bedrooms.9 Number of baths Lot ____________________ <br /> Water Supply: Public system E] Community system E] Private ❑ <br /> Character of soil to a depth of 3 feet:' Sand E] Gravel E] Sandy Loam Ej Clay Loam F] Clay E] <br /> Adobe X Hardpan 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ? i <br /> (No septic tank or cesspool permitted if public sewer is available within 200 febt.) <br /> Septic Tank: Distance from nearest welk-0-----------Distance from folunclatiolIAN---------Material------------------------------------------------ <br /> No. of compartmenis----------- Capacity------------- --------Size---r -----------------------Liquid depth--------------------------- <br /> F1 I - -.i----- <br /> Cesspool: Distance from nearest well--------____-_Distance from founclation'_--]---------------Lining material-_____.____-----.-. <br /> - Size: Diameter--------------------------- `V-Depth----------------- - --I-- ! <br /> - --- <br /> Privy. Distance from nearist well----------------------------------------------'-Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest,lot line__________________________----- _______.._. - <br /> See Rae Pit: _-DI-stance-to nearest'w.,e11_A69PY.4?-*Dist from foundation, ------- Distance to nearest lot <br /> Number of pits'-- I Lining material N�Imk;l---Size- Dia mete r__ Depth <br /> I nearest ------ :V------- -------------------- <br /> -Disposal Field: Distance from nearest well -------- --Distance from foundation--nA-----------Distance to nearest lot line---------------- <br /> Number of line.s---------- well <br /> - L 6--ii Width of trench----------------------------------- <br /> -------- -'ril------\_Lengfh of each line------------------------------ <br /> El I i ri'll� <br /> 1 Type#­61f�filter material---- __1De pt ,f fi er materi <br /> -- ---------- <br /> ---- ----- --- <br /> 'Remodeling and/offrepairing (describe):---__-_'s--!-- <br /> ----------------------- j-------- --------- -7�---------------- <br /> ------------------------------ <br /> --------------------------- ------------------------------------------ <br /> k <br /> ----------------------------------- ----------------- -- -1 -------------------------------------------------1- <br /> ---------------)-------------------------------------------- ----------------- i---------------------------- <br /> i ---------------------- <br /> ---------------------------------- ------------------------------------------ ----------------------------------------- ----------------------------------------------------- <br /> , *ion and Vgone in accordance with San Joaquin County <br /> I hereby certify that I have prepared 06' <br /> p Ica at the work wil <br /> ordinances, State s, a rules and` re ulati 6 of the San aquin al He bisfrict. <br /> 4L --------------- :jOwner a" or Cotractor) <br /> (Signed)] -------- ------- --------- C�, a,31fory <br /> ---- - ------------ <br /> ------------ <br /> y� <br /> B ---------------- -- --- -- ------------ ------- -- (Title)------ - <br /> (Plot plaris, showing size of lot, location of systi'6rn in�qla.fibn o wells. buildings, etc,., must be fileddth this application). <br /> FdR.'15EPARTMENT USE ONLYi. <br /> APPLICATION ACCEPTED BY---------- ----------- DATE----- ---- <br /> ----------- <br /> REVIEWEDBY----------------- -------------------- ----------- DATE------------------------------------------------------------- <br /> BUILDING,RERMI-T-ISSUED2'-___—-- ---y-------- ---------------------------•------------------ ------------ DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations:--------------------------------------------------------------------------I--------------------- ----------------------•---------------------------------------I-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------­ <br /> ---------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- <br /> ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------7------------------------------------ <br /> 11-1 XV <br /> PERMIT No._S.011 _0-------- ISSUED.--ED ---jj_��7_1-----------(Date) FINAL INSPECTION BY- -------- --- ---VU - <br /> ----- ------ --------- ---------- <br /> Date------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 Wd639 <br />