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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---------------526---S_o.____Sn01air--_Avg;____St-ockt_on,----Gal.i-f-a-------------------------------------- <br /> --------------------------J•----B.--_Laude da1e------------------------------------------------------ Phone---------------------------•-------- <br /> Owner's Name____________________ <br /> Address---------------------------------------------------------------826-- ---A"vei-------------------------------------------------------------- -------------------- <br /> Contractor's Name-----------------------------------D..-_A ---FAP.HISH---&--3-0YS-r---INC--.------------------y------------ Phone-------9"96-0-7----------- <br /> nstallation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ]0 Number of bedrooms 21 Number of baths ❑1 Lot size---------- <br /> - - ------------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depf�43 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M 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---KQ!1a__Distance from foundation___1W---------Material-------C------G___Br-i-ek___________- <br /> No. of compartments---------2--------------Capacity------800---G---Size--56ff-x36tl-x�6,31ILiquid depth------52-------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__________________-__-___-__________ <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> "Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___--_ -----________________-__________- <br /> ❑ Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well----Xone------Distance from foundation------5Q=-------Dist Distance to nearest lot line----81-------- <br /> KI Number of pits-------1------------Lining material___-CC---Br-16te: Diameter----33 p . <br /> Disposal Field:. Distance from nearest well---1,(MP____.Distance from foundation---2 ..........Distance to nearest lot line____ 1__-_--_ <br /> KI Number of lines_________ ______ _____________ __Length of each line-------5Q1-______-_-___-.Width of french______2V!------------ <br /> Type <br /> ____ __Type of filter mate iaL___- _Depth of filter material------18"--_______ <br /> Remodeling and/or repairing (describe):------------�j-e of--ins- -a-1-1 3.tiion-------------------------------------•------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------•------- <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 laws, and rules and' regulations of the San Joaquin Local Health District. <br /> (Signed)------------ .1A q_1 &Td---& ING.------------------------------------------- ------------------------------- Contractor) <br /> Sy:------- -- --------- - ----- - -----------------------------------------(Title)------Estimatnr------------------------------- <br /> (Plot plans, sh wi g sizocation of system in r tion to IIs, buildings, etc., must be filed with this application). <br /> FCWDEPARTMENT US ONLY <br /> APPLICATION ACCEPTED BY ---- --- ---------------- DATE <br /> REVIEWED BY------------------------------- �. ���®,1 DATE - '"" � _7- <br /> BUILDING PERMIT-ISSUED---------,.W- ----- - - <br /> DATE <br /> y- <br /> Alterationsand/or recommend atioris--------------------------------------------------------------------------------•---------------------------------------------------------------_------------- <br /> -------------------­--------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------ -------------------------------------------•-------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------ <br /> - - --------------------------------------------- -------------------- <br /> -l-____- ISSUED-______ ___.1'_7- /r y___(Date] FINAL INSPECTION BY:--________"-—v___1--................................... <br /> PERMIT No.--� f *� � <br /> / <br /> Date-------------------- �'`� d_--)------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />