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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. d;. <br /> JOB ADDRESS AND LOCATION---------------6 -------------------------_--------------=--------- <br /> Owner's Name---------------------------- <br /> -------------------S-ul --P ------------------------------------------- Phone---r6R05------•------ <br /> Address 6 No -Sinclair Aver Stockton -------------------------------------------------------------- <br /> --------------------------------'------•--------------------------•--- ------------------ j <br /> Contractor's Name-----------------'--------------------D.----A- I►� f}� -7 Zt �r- Phone �''�6Q7 I <br /> Installation will serve: Residence [X Apartment House :❑ Commercial ❑ Trailer 'Court ❑ Motel ❑ Other ❑ <br /> f <br /> Number of living units: 10 Number of bedrooms Z] Number of baths [2 - Lot size---_5 1_�-001------------------------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private <br />" Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam El Clay Loam E] Clay ❑ Adobe E] 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 <br /> Y foundation--------------------Material____--------______- <br /> -__-____---__----_____---__ <br /> EXutirig No. of compartments--------------------------Capacity-----------------------Size--------------------• • ----_-_Liquid depth-------------------------- <br /> Distance <br /> __---___-----_--------- <br /> Distance from nearest well----------------- from foundation--------------------Lining material----_---______-_---___----__-__----- <br /> , <br /> Cesspool: <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: <br /> -------------------- -----------------------------Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------- <br /> ❑ Distance to nearest lot line------------------------------------------------ <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 /> e <br /> Disposal Field: Distance from nearest well-------501----Distance from foundation _-_?Q-_------.Distance to nearest lot lint,---- ---------- <br /> X] Number of lines-------1---------i_f;_------___Length of each line---�Q----------------------Width of trench--------- 4 --__-------_-----_ <br /> Type of filter material-____ - ___------�Pepth of filter material-------1$-_.......... <br /> • ------------------------- <br /> Remodeling and/or repairing (describe-----------5�-�?p�-emen.t---�-4---dra�na_�e-__SyS�em �_A_____________________ <br /> ----------------------------------------------------------------------- <br /> ------------- ------------ ------------ -------------------------------------------------------`------------------------------------------------------------------------------•----------------------•-------- <br /> I hereby certify that I have prepared this application and that +he 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),---- Ki - ----- -4...luc-----------------•-------V---------------4-----------------------'----------------(0@j&yffjjW Contractor) <br /> BY: ro <br /> (Title] ESTIMATOR <br /> A----- - --- --- ---------------------------- <br /> (Piot pl s, s ng size o of, location of Vern in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE--- ----------------------------------------------------------- <br /> = = - 4 <br /> ----------------------------------------------------------------------------- <br /> REVIEWEDBY------------------------- -------- ------------------------------- -- --------- DATE--------�-� <br /> -------------- - -- DATE 4� <br /> BUILDING PERMIT ISSUED-------- <br /> Alterations and/or recommendations-------------------------- ------------------------------------------------•------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------ <br /> ----- - -------- --------------------------------------------------------------------- ------------------------------------------------•--- <br /> --------------------------- <br /> - -- <br /> ISSUED----_---_ _-1-- - ---J -..--{Date) FINAL INSPECTION BY:____ --------- <br /> --------------------------- <br /> Date <br /> - . <br /> PERMIT No --------------------- <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 />