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Fill <br /> f <br /> `PPLICATION 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 /> .�— `---------------------------------------------------------- <br /> JOB ADDRESS AN� LOCATION_,____ �__�_ __!�_._.�._�____�� ,/ <br /> Owner's Name V • i Phone--` '".-�Q�? <br /> Address-------------------------------------------/--------------------------- ------------------------ <br /> Contractor's Name.............�., r �------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ❑ Number of bedrooms ❑ Number of batl;l`❑ Lot size....._-•____________________________•___-_----•_-•--____-_•-_- <br /> Water Supply: Public system ❑ Community system ❑ Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑_ Adobe ardpan ❑'�� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: k ' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----A��7lDistance fr m found tion----- ......Mate ial_-_•___ ------ <br /> No. of compartments_______________Capacity___ _ ___ _Size _ _x. __ _Liquid depth._. ._.fit. <br /> Cesspool: Distance from nearest well_______________•_Distance from foundation....................Lining material_-__-___----________--_-_________-_-•. <br /> ❑ 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----------------------Distance from foundation-___-__--___-----_.Distance to nearest lot line................. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------__.__-----.Depth--------------------------------- <br /> Disposal Field: Distance from nearest well..,&r7.t-?..Distance from foundation__LS_�---__-__Distance to nearest lot line�___1( <br /> Number of lines........../---t---------------Length of each line,/".-,V_70'—.Width of trench........A-41............... <br /> Type of filter material... __—....Depth of filter material___ <br /> Remodeling and/or re firing ----------------------------------- <br /> (describe):------ .. t- ------40---w -------ZU- -C-0�... -------- - ------ <br /> -----------------•----------•--------------------------------------------- <br /> _---- <br /> ------ <br /> -------------------- --------------- ------------------------•------------------------------------------------------------------------------------------------------------------•- --•------------------•--------- i <br /> ---------------------------------------------------------------------------------- --------------------------------------------------- ------------ --------------------------------------- ------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, a rules and regulations of the San Joaquin Local Health District. `� <br /> (Signed)-- t --- - --------------------------------------------------------------------------------------------- ----(Owner and/or Contractor) <br /> By:------------------ --- ---------------------------------------------------------------------------------------------------------(Title)--------------------------•------------------------------------ <br /> (Plot plans, showing size of lot, to ion of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------_ v <br /> DATE----------� - .5+ <br /> REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE---------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------------........ <br /> te/Y t <br /> ions and/or rec men afiions____________ _ <br /> — s. i <br /> ---------------------------/ /� <br /> ------ �----- � ---- <br /> ----------------------------------------------------------------- ------- -------------------- <br /> ------------------------------------------------- -- <br /> -------------------------------------------------------------------------------------------------................................................... -- <br /> ---------••-----------v-----------•-•.. . <br /> PERMIT No.._-,*....._ ISSUED__.._-Y-- <br /> l__--- ---_---�-......(Date) FINAL INSPECTION BY______________ __ ___. z-- ......... <br /> 1 <br /> Date..................... <br /> ---------� #--�----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT / ,. ' <br /> 130 South American Street <br /> Stockton,California <br /> ES-9-2M 9-50 W-1639 <br />