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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.Y54 <br /> JOB ADDRESS AND LOCATION---- <br /> Owner I s Name----4 06, A' ---------;Ppv --------------------------------------------------------- Phone------------------------------------ <br /> Address------Z3,?-K <br /> Contractor's Name---- r'-C------ ------------------------------------------------------------------- PhonZ-W----------------- <br /> Installation will serve: Residence Y Apartment House F] Commercial [-] Trailer Court E] Motel E] Other E] <br /> Number of living units: L2^ Number of bedrooms 2L Number of baths Ed Lot size----1„a_- ------ ---------------------- <br /> Water Supply: Public system_x Community system F7 Private ❑ <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F Sandy Loam EClay Loam 0 Clay EAdobe r <br /> Hardpan E] <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--------------------Material------------------------------------------------ <br /> 4j[;tZ;La No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth------------- -------- <br /> Cesspool:Cesspool: Distance from nearest well_________________Distance from foundation-----_----_-__-----.Lining material-_--____---______--_-------__-__ <br /> ❑ <br /> aterial---------------------------------El Size: Diameter--------------------------------------Depth----------------------------------------------------- <br /> �Priivy: Distance from nearest well-------------------------------------------------Distance from nearest building--_-------_-__------_--------------------- <br /> El Distance to nearest lot line <br /> See,Rpa e Pit: Distance to nearest well___ ----—--------Distance f rom foundation -- <br /> - _-,10' <br /> ? 0 Distance to nearest lot line_ _O-------- <br /> Number of pits------/--------------Lining materiaI__??.-i.__*41A _Size: Diameter___-_ <br /> DiRl Field: Distance from nearest well---"6--—------Distance from foundation----/A-40-----Distance to nearest lot line----- <br /> Number of lines___________ -------Lengfh of each line---I_?_W '* <br /> zb.x� ------------Width of trench__-'- <br /> ,,r-;K__Depth of filter material____ D -'e <br /> j 0----------- <br /> Type of filter material-------0. <br /> Remodeling and/or repairing.(clescribe):------- ---------------------------------------------------------------------------------------------------- <br /> I---------------------------------------------j--------------------------------------------------------------------------------------------------------------------------------------------_--------------------_-----------t <br /> ---------------------------------------------------------------------------I----------------11------------------------------------------------------------------------------------------------------------------------------ <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 /> ordinances, State lalv, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---OkA ----------------------------------------------------------- (9%m�.40/or Contractor) <br /> Aft— - - ­ -- K W — <br /> -L 777:7=----------------------------------------------------------------------- ----------------------------- <br /> By: -------- - �L 0--ool <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---------- -W_ --------------------- ----------------------------------------- DATE------ �^ <br /> REVIEWED <br /> ATE------- <br /> REVIEWED BY--------------------------------- <br /> ------------------------------------------------------------------- ------------------------ DATE <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------.__ DATE --------*------- <br /> --------------------- <br /> Alterations and/or recommendations:-_------ ------------------------------------ <br /> ----------------------I-------------------------------------------------------I---------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------ -------------------------1--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------- ------------------------------------------------- -----------------------------------------------------------:---------------------------------------------------------------------------------- <br /> PERM IT No.7 ---y---------- ISSUED--------V�_Vxl--------(Date) FINAL INSPECTION BY:----__.__ V <br /> Date------------ ~ r <br /> SAN <br /> ate------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ES-9-2M9-50 W�1639 Stockton, California <br />