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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health Disfrict 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-,-, <br /> 31A <br /> ---------------------------------------------------------------------------------------------------- <br /> Owner's Name--- <br /> V-4----------------------------------------------- --------------------------------------- Phon <br /> (7 71 <br /> Address----I,-_1�----17_7 S41 ------ <br /> ---I------ <br /> ------- -------- <br /> ------- ---- ------------------------------------------------------------------------------------------------------------- <br /> Contractor's -. - __7--------- <br /> -------------------------------------------------------- Phone- <br /> -will serve: Residence, Apartment House E] Commercial ❑El Trailer Court 0 Motel El -Other E]----------- <br /> Number of living units: -[P' Number of bedrooms J!7 Number of baths 0 Lot size---- <br /> Wafer Supply: Public system E] Community system E] Private'w-Z I -- I I ------------------ <br /> Character of soil to a depth of 3 1 feet: Sand 0 Gravel E] Sandy' Loam E]" Clay Loam E] Clay 0 Adobe Hardpan Ej <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 weil---- <br /> _'o-_/-_Distance from foundaf;on__.__kq_, <br /> No. of compartments----------ZZ-1----------Capacity-----A? -----Material -------------------/----------- <br /> el-A-------Size-!A0A'-�-'A7Pt_Liquid depfh,S_�>_,,--- <br /> Cesspool: Distance from nearest well--"_____________ Distance from foundation--------------------Lining material__---_-_-_-_----_--_-__- -- -Size: Diameter--------------------------------------Depth---------I----------------------------------------- <br /> Privy: ? 041 <br /> Distance from nearest-well-----------------------------i--------I----------Distance from nearest building-' <br /> 0 Distance to nearest Jot line ---------------------------------------- <br /> ----------------------- ---------- <br /> Seepage Pit: Distance to nearest well-__-- Distance from foundation---__-_41­�L--------Distance to nearest ]of line_4._� <br /> Number of pits-------/------------Lining maferial_a4_494�_,---Size.,Diam-e-fer------_W..............Depth---2 -n <br /> Oisposal Field: Distance from nearest well----7-b-Z_Distance from foundation----- <br /> Number of lines---------- ---------Distance to nearest lot line---Is---------- <br /> Type of filter material-l-k-11"--7---------Length of each line_ ---- -------------Width of frenchY-" <br /> A <br /> ftse-12--Depth of filter material--_-_ - _--- <br /> -and/or repairing —-------------------------------------------------------------------------------- <br /> ----­---------- ------------------------------------------------? ---------- <br /> ------------------------------------------------------------------------------*-------------------------------------------------- <br /> ------------------------------------------------------------------------------ --------------C----------- --------------------------------------------I-------------------------------------------------------------- <br /> ------------------------------- ------------------------------- ------------------------------------------w <br /> that the work will be done in accordance with San Joaquin County <br /> I hereby certify that I have prep�red this application and - -------------------------------------------------------------------------------------------- <br /> ordinances, State laws, and rules and.'regulafions of the San Joaquin Local Health District. <br /> (Signed)-_ZRA!--- -------------------------- - <br /> ----------------------------------------------------------(QXPer- 4/or Contractor) <br /> - -------------------------------------------------------------------------(Title <br /> (Plot Plans, Showing size of lot, location -----------------------.of system iwrelation to wells, buildings, etc., must be filed with this application). <br /> ----- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- <br /> -------------------------------------------------------- DATE___--_-_ <br /> REVIEWED BY . / e0�)_ -------- <br /> U_E_D--------------------------------------------------------------------------------------------------------- DATE-------------- <br /> BUILDING PERMIT ISS ------------/ - --------------------- <br /> -------------------------------------------------------------------= <br /> ----------------- ------------------------------ DATE <br /> Alterations and/or recommendations: <br /> -------------------------------------------------------------------I-----------------------------------------------I---------------------------------------------------------------I-------- -------------------------- <br /> ------------------------------------------------------------------- ---------------------------------------- --- <br /> ----------------------------------------------------------------- <br /> -- -----------------------------------------------I---------------------------------------------------------------__ <br /> -----------------------------------------------------------------------------I--------------------------------------------------------------------------- <br /> -----------------------------I------------------------------------- -------------------------------------------I----------------------------------------------------- <br /> ----------------------------------------------- <br /> PERMIT No._&_v--------- ISSUED-----_//_'_.Z -5�------(Date) FINAL INSPECTION BY:-h,- - -------------------------- <br /> Date.-//;x . ....rl <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> B-9-2M 9-50 W-1639 Stockton, California <br />