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. � l <br /> 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-_ ,---7t"' tlr- y------- --------------------------------------------------------------- <br /> Owner's Name--- -y-i-- �?Q �^" -- ------------- <br /> -------------- - -------------------- Phone------------------------------------ <br /> Address---------------1-19. itst„G -S . -, ' "4'� 111`fit__ <br /> -- ------------------------------------------------------------------------------------------------------ <br /> Contractor s Name----lit�/-r------- ---- - _Y1"1'1---- k--- -------------- <br /> ------ -- --------------------------- Phone-------------------- <br /> --------------- <br /> Installation will serve: Residence 0--A-'partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .[] Number of bedrooms [Z] Number of baths Z Lot'size___,J_p___X___/ '�, -_ - <br /> - -------------------------- <br /> Water Supply: Public system FRO'O'Communify system ❑ Private ❑ <br /> ? Character of soil to a depth.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9?'T�ardpan Ft-L.— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic an <br /> k: Distance from nearest well- -- <br /> p. Distance from foundatio/n__, _Q_________,Material__ _ ?___'-__"_ ,_ `+ ' <br /> No. of compartments----------tyYC <br /> --------Capacity---f L1ze -"_Liquid depth------1�-------- <br /> cesspool: Distance from nearest welL�p g <br /> P - _ Distance from foundation-------------------- material_________.______-_________________- <br /> ❑ Size: Diameter--------------------------------------Depth---------/---------------=------------------------- <br /> Privy: Distance from nearest well______ --------,o -Distance from nearest building___ <br /> �❑ 1 Distance to nearest lot --------------#_ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------- _----_ <br /> ❑ _ Number of pits----------------------Lining material-----------------------Size: Diameter---------------.--------Depth____________________-_ <br /> Disp_ o l Field: Distancb from nearesrt well__ ___/���Distance from foundation___: T__-Distance to nearest lot line—LA__f__: <br /> Number of lines----------------- -- --- `? <br /> ----:----Length of each.line----------�_�?________--.Width of trench-------- --------------- <br /> Type of filter material-_____________________-_Depth of filter material___-__.______________ <br /> ----- <br /> -Remodeling and/or repairing (describe):----- --- -------- #_� ------•----------------------------------•---------------- ----------------------- <br /> t- ------------------------•-------------•--------------•--------•-•----------•-•------------------------------------------------------------------------------------------------------------------------------"I-----------` <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------------------------------------------------------------------------' <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinan , tate la s, rules and regulations of the San Joaquin Local Health District. <br /> (Signed).- ----------------------------------------- <br /> ___------------------------(Owner and/or Contractor) <br /> BY• --F <br /> •--------------- ---------------------------------------------------------------------- <br /> -- - -------='�---_=--=--`------------------(Title)----------------------------- -------------------------------- - <br /> (Plot plans, showing size of lot, location of system in relation to wells; buildings, etc., must be filed with this application). <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y r ' 't- <br /> �'.z _ = -- DATE -,- --1-f—­�---Z--------------- <br /> REVIEWEDBY------------------------------------I`----------------------------------------- ------------------------ -------------- DATE---------- <br /> ;' BUILDING PERMIT ISSUED---------------------------------------------------------- DATE._..--------------------- <br /> Alterations and/or recommendations: --- ----- - "`` _ <br /> ----------------------------------------------------------------- - '' e,6.v `"~ � C1----_Y=-` �� <br /> ,._ <br /> ------------------------_----- ---------------------------------------------- ==---------------------------------------------------------------------------------------------------------- ----- ------------------------ <br /> PERMIT No.,_v -4------------- ISSUED__ ----------(Date) FINAL INSPECTION BY:-_______—W-------------------------------------------- <br /> Date----------------------� <br /> eV% SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br /> i <br /> i <br />