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.S 3u <br /> APPLICATION FOR SANITATION PERMIT T �• �" �'�7/ <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. .9 <br /> This application is made in .compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---a),__7_Z-d------- --- ------ - t----—- ---------------------------------------------------------- <br /> Owner's Name---lam!/ ---- P&I-Z----------------------------------------- Phone----------------------------------- <br /> Address..... <br /> ----------------------------------Address..... _706-a---- -- - ------- -------- ---------------------- -------------- <br /> --=----------------------------------------------------------------- <br /> Contractor's Name_.-- __� x _ Phone__ !- <br /> q / <br /> Installation will serve: Residence Apartment House 0-0<01 ercial ❑ Trailer Court F1 Motel [I Other El1\ t <br /> Number of living units: ) ] Number of bedroom Number of baths [ Lot size-_-�.� _____ ------- ____-_.: _____ <br /> Water Supply: Public system ❑ Community system b1Pr1vafe*9 V <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑. Clay Loam ❑ Clay ❑ Adobe_X Hardpan..❑,`. <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 well___,��_____Distance from foundation-_____T------_.Material___ � -------------- <br /> 4%. <br /> _�_____----. <br /> No. of compartments--------J-------------Capacity----��_q-_-----Size-------� �-�-�-�'--Liquid depth__,��--------------- <br /> Cesspool: Distance. om nearest well_________________Distance from foundation--------------------Lining material------------------------------------- <br /> ❑ Size- Diameter--------------------------------------Depth---------------------------- <br /> � -------------- ----------------- <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_____--.__-____.__----_____________--._.. <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> Seeps a Pit: Distance to nearest well_---.I_47Q......Distance from fo ndation_____> _r_____Distance to nearest lot line_____7+------- <br /> Number of pits-----/ •- ----Lining materia_ Size: Diameter__ � - _Depth-..')-p-----f <br /> -•---------------- <br /> - - -^' <br /> Disposal Field: Distance from nearest well--- _r__.Distance from foundation_____].2E.-----Distance to nearest lot line------ ------- <br /> Number <br /> of lines----.-------/--------------------Length of each line------So-_R_____-_____.Width of french-___-2-4_ ------_.-__'_____ <br /> Type of filter material_ __ ----Depth of filter material______18-" * <br /> Remodelingand/or repairing (describe):------------------ --------------------------------------------------------------------------- •------------------------------------------------------- <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 /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) - � <br /> t �' ---------------------------------=------------------------------------------- . ------tor Contractor) <br /> ------------------------------------------------------------ Title ,.�r�-+ <br /> BY� -- (Title) <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, efc., must be filed with this applicafion). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ '�_ ----------- --- ---------------------------------------- DATE <br /> -- ----------------------------• DATE --,�-7 s -------------------------- <br /> REVIEWED BY------------------------------------------------------------- - -- ----------- ------ - t-- <br /> BUILDINGPERMIT ISSUED----------------- ------------------------------------------------------------------------------------ DATE---------------------------------------------------•--•---•- <br /> # Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------••---------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------•-------------­­-------------- -------- ------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> PERMIT No._3�-1___________ 155UED_______� L---57---------(Date) .FINAL INSPECTION BY:________ <br /> /rz e)Z#2--------------------- <br /> i 1 <br /> Date--------- ---- = ------------------------------------------------- <br /> SAN <br /> ------ -----------------------------------•-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />