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&�. <br /> rp <br /> APPLICATION FOR SANITATION PERMIT <br /> y (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 AND <br /> f�LOCATION--------r.�3__4--- -------�� ------ -�-��------------ -------------- <br /> ----------------------------------------------- <br /> Owner's Name---- / l_ dy --'- '---------------------------- -- Phone d---7-�--'-j <br /> f <br /> ¢� - --_--- -------- <br /> Address---- 3 �-C--- --- <br /> ----------------------------------- <br /> Contractor's ------------ ------------------------------ Phone <br /> .Installation will serve: Residence 12/Apartmenf House ❑ mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: [Z Number of bedrooms Number of baths Q Lot ________-------------- <br /> Water Supply:I Public system �ommunity system E] Private ❑ <br />` Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay El Adobe Hardpan" <br /> h TYPE OF INSTALLATION AND SPECIFICATIONS: } <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta k: Distance from nearest well-------—-----Distance from foundation <br />!' foundationatAria------ _ _��___-___- <br /> __:Li:Liquid de fh____'�—of compartments------------Q----- Ca Capacity CT-V--- __X . <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material___-_____-__--_____________-________. <br /> s>- Size: Diameter--------------------------------------Depth---------------------------------- <br /> Privy: ' Distance.from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> p g Distance to nearest lot line------------------------------------------------ <br /> I <br /> See❑a a Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------- <br /> " <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----•-------------------Depth-------------------_-----_------- <br /> Disposal eId: Distance from nearest well--- Distance from foundation------/4 `___Distance to nearest lot line----�_�___ <br /> Number of lines-------------y---------------Length of each line--------�?0__________---Width of trench_-_-- -f�_•r---------------- <br /> Type of filter material__---__Depth of filter material-______- ______ <br /> Remodeling and/or repairing (describe):---------- _------- -'-"- - -- f ----------- <br /> ----------------­­----------------------------------- <br /> ----'_-----------------•-------------------------------•-------- ------- -- _ - ---- `=:..'---,- -�'"'A*... . <br /> -------------------------------------------------------- •------------------------------------------- •------------------------ - ----------------------- ---------- <br /> ---------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- - ------rt - ---- <br /> { I hereby ertify that I have prepared this application and that.the work will be done in accordance with San Joaq n County <br /> ordinances, ate I ws, and ru es and regulations of the San Joaquin Local Health District. <br /> (Signed)__ .... - -------------------------------------------- _ (Owner and/or Contractor) <br /> ---- ----------------------- ----------------------------------------------- ---------------------------------------------(Tale)-------------- -- -------------------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- tpe- ------------------- DATE-----------/at 'Z ` <br /> REVIEWEDBY------------------------- - °'� - ---------------------------------- DATE---------- /0 ---_'- ,t .lZ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations_________________________ _•--______ <br /> ----------------03— --`"` s---------------------------------------------- <br /> ------- <br /> ----------------------------------------------------- ---------------------------------------------------------------------- ------------------------------------------------•-------------------•-------------------------- <br /> --------------------------------I--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------'=--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> PERMIT No.------ �---------- ISSUED------ `� ~�� �c`��------(Date) FINAL INSPECTION BY:--------V----------------- <br /> Date------------------'- 1 - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9--2M 9-50 W=1639 <br />