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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. <br /> JOB' ADDRESS AND LOCATION.----!-4t-`----------� ---------------------------------------------------------------------------------------------------------- -------------`fir-- �- ' <br /> l4Phone--�"�_3_�_1_ ------ <br /> iOwners Name--------------+------- -- - ---------------------------- ------------------------ ------------ <br /> Address--------------------------------- &L- es ---------------------------------------------------------------------------------------------------- <br /> Contractor's Name---------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> I Number of living units: '❑ Number of bedrooms ❑ Number of. baths ❑ Lot size--------- «� <br /> �, ---1C._- �.0--- <br /> -------------------- <br /> Water Supply: Public system [x Community system ❑ Private ❑ <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 240 feet.) <br /> N <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material .______.---.--_________________________________- ` <br /> ❑ No. of compartments-------------------------Capacity-----------------------Size----------,---/-- --------------Liquid depth-------------------------- <br /> Ce s pool: Distance from nearest well_______,__`__�_____Distance from, forndation------� '___.Lining material_________ _____________ <br />' Size: Diameter--- - Depth--- L- --------------------------- <br /> - <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building:----------------- ----------------------- <br /> El <br /> ---_______`"______}❑ Distance to nearest lot line------------------------------------------------ <br /> I` Seepage Pit: Distance to nearest well______________________Distance from foundation--------------------Distance to nearest lot line_____________:__ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------.--------------.Depth----_---------------__--__------- <br /> Dis osal Field: Distance from nearest well------------------Distance from foundation-----------------..-Distance,to nearest lot __._______-_._ <br /> p <br /> ► , .� . ❑- : .^.Number- f-lines------- ---�Leng h of"each-line - t o trench <br /> Type of filter material-------------------------Depth of filter material---------______________ <br /> Remodeling and/or repairing (describe):------ --------6------ ��5 '--------------- <br /> -------------------------- �`J --- ---- `�! i <br /> --------------- ------------------------- <br /> I hereby ce ' y that 1 have prepared this applicati rt'and that the work will be done in accordance with San Joaquin County <br /> ordinances, StateE s, and rules and' re ulationsKKof the San Joaquin Local Health District. <br /> Sined r -------------- ----------------------------------------------(Owner and/or Contractor),_ <br /> g ) �= <br /> BYL-------•------------------------____--------------------------------------------------------------------------------------------(Title)--------------------------------------------------- ----(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---------------------------------- --- DATE----------- ; ----------------------- <br /> REVIEWED BY - --------------- DATE <br /> ----------------/------- --------------------------- <br /> ---------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------- - - --------- -----}---------- -------- <br /> Alterationsand/or recommendations-----------------•----------------------------------------------------------------------------------------------------------------------- -- ---- <br /> ---------------------------------•---------------------------------------------------------------••---------------------------------------------------------------------•------------------------- ---------------------- <br /> -------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------------------------•----------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- <br /> ---------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 1v &, fA <br /> PERMIT No--------�� ---- ISSUED----�' - ---------(Date) FINAL INSPECTION BY--------------------- d-�'-- ---� 7-------------------- <br /> Date----------------7y7M _/--------------------- ------ ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 134 South American Street <br /> ' Stockton, California � 1 <br /> ES-9-2M 9.50 W=1639 <br />