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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. t1 <br /> JOB ADDRESS AND LOCATION-----'�_Z---7F---------• o v Q�"� ---------- ��Iz, -- ------------ -� <br /> -------------- t <br /> Owner's Name------------------- ---------Y-'-------------0,4Z,4Y--------------------------------------------------------- Phone---- <br /> Address------ <br /> --Address------ a-152--0--------...:�--r-------------------•-------•-------.------- <br /> -- r,14 <br /> .. 6--i3--Contractor's Name-------. - ------ --------------- Phone--------•--•---------- <br /> i <br /> Installation will serve: Residence-0 Apartment House ❑ -Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 0 Number of bedrooms Q, Number of baths 0 Lot size______ --------------------------- <br /> Water <br /> _________________________Water Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 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 /> i rr <br /> Septic Tank: Distance from nearest well__ .Distance from foundation..../.0_- '__.Material..._ f 3 _____________ <br /> No. of compartments--------:�,._-----------Capacity-----w_v------Size___ _x__ -�C_ _____Liquid depth.---44- <br /> Cesspool: Distance from nearest well----_------------Distance from foundation--------------------Lining material_____________________________________ p <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well--------_----------------------------------------Distance from nearest building------------------------------------------ <br /> E-I Distance to nearest lotline________________________________________________ <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_ Distance from'foundation__ _____.-Distance to nearest lot hne___ ��_��_ <br /> Number of lines____________a Length of each line---------'��a_' _ Width of trench--------2__ _`4_________.__ <br /> --2rh,. <br /> Type of filter material---.�__�______________Depth of filter material---------/P-`'_____ i <br /> Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 3 <br /> ___________________•-_--_------___-___--__________-___---____________________________________--------_--..__--_--_--__-__--______-_______.________________________-___________--__________-__-________________________________ ♦' <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 /> ordinance State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) . . ........ (-...--/-•--'---------=-------- ------------------------------------------------------------------------------(Owner and/or Contractor) <br /> Y•-------------------------------------------------------------------------------------------- -------- -- --- - -- ---- ----_._(Title)---------------------------------------------------------------- <br /> (Plot plans, showing 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------------------------------ko- - - ---- --------------------------------------- DATE---------- w ---------------- <br /> REVIEWEDBY---------•---------------------•------------------------ ------------------------------------------------------------------ DATE------------------------------------ <br /> BUILDING PERMITISSUED-------------------------------------------------------------------------------------- ------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> j ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 4 <br /> ----------------------------------------------------------------- --- ---------------------•----------------------------------------- ---------------------------------------------------------------------- <br /> PERMIT No.._�_�_�____ ___ _ ISSUED------ ---/ Date) FINAL INSPECTION 8Y:______________ <br /> Date------ - ----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> 'ter <br /> ES--9-2lv1 9-50 W=1634 <br />