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APPLICATION FOR <br /> 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 AN LOCAT N.._. ..........so..._-------- <br /> Owner's Name--- • <br /> ---------------- Phone... ---- <br /> Address-----Z16---(P...$-t-------'- <br /> ---- 2n 7 <br /> Contractor's Name-----AX--- '` 6...A.----�--_--- -_■_,..�.------------------- <br /> Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 4. Number of bedrooms Number of baths V Lot size__.1,4f...... /_, ....i..................... <br /> Water Supply: Public system ❑ Community system ❑ Private 04 <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 /> p - ry� ... © - .Material- .+ <br /> Septic Distance from nearest well_�`_�_._Distance from foundation ,..G� <br /> No. of compartments._.____..._.___-----Capacity---C- i -_----Size--XJC---A-_31...Liquid depth---,�— ..-.. <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_---�.1t '.�---Distance from fo_indation----/_l_!_..6istance to nearest lot line--- <br /> Number of pits.......I-------------Lining material__ '.'- %0C4-size: Diameter.._.3*3............Depth------A0./-------. --- <br /> Dispos I Field: Distance from nearest well-_J_.-Q-__.Distance from foundation...,,=ti_�....Distance to nearest lot line...1_�1_-_---- <br /> --- g 4! r ---.Width of trench......2-Y I--------------•-- <br /> Type � ___._. Length of each line.__.._ � _. .__._ <br /> T u e of filter material_. _. �_.De th of filter matenal____...�_____--._ <br /> Remodeling and/or repairing (describe):-------------------------------------------------------------- -----------•--------------------•------•-----•-•-------------------------------•------ <br /> ----------------------------------------•-------------------------------------r--------------------------------------------------------------------------------------------------------------------.......................... <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, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)••-1t —- <br /> 7w s..r /or Contractor) <br /> By:... •- ----- ------- ----- _---------- ---------------------------------------------(Title)--- -----------_-- <br /> (Plot plans, s owing size of lot, location of system in relation to wells, buildings, etc.,must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------------------- -•-- --------------------------------------- DATE---------- orf - <br /> REVIEWEDBY -- ---------------------------------------------------------------- DATE---------- ................ <br /> BUILDING PERMIT ISSUED = --------------• DATE----------------_------------------ -- <br /> Alterationsand/or recommendations:-----------------------------------------------------------•---------------------------------•-------_----------•--------------•------------------•------------ <br /> ----•-------------------------------------------------•-----------------------------------------------------------------------------------------------------------•------------------------------------------•---------------- <br /> -------------------•---------------------•--------------------------------•---------------------------------.-------------------------•-------------------•-------......------.......--------------------------------.••.... <br /> •-----------------------------------------------------------•------------------------------•------------------------------------------ •------------------------•---------------------------------------------------•- <br /> ••-•----•-•---•-----------------•----••-•-•-------------••--•-----••--•-•-•------------•--•-------•••••-••-.....-•------•---•---•----•-------•---•--------------------------------..................................------ <br /> PERMIT NO.__JJ -5......_ ISSUED.__...., - ........(Date) FINAL INSPECTION BY:--------W_J_.__ <br /> ............................................... . <br /> Date--------------------- ........................................................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES 9-2M 9-50 W-1639 <br />