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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--------3'------ l�-` ,00lt.& ---- <br /> - ---------------------------------------------------------------------------- <br /> Owner's Name--------q�- AI------- ------------------------------------------------------ -------------------------------------- Phone------``" --------------- <br /> Address--------------------7(ill'Y_1isa -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name-------- ---- - -- -----•------------------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: Number of bedrooms FaL Number of baths P Lot size_____'_ _ Q--j----------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ® (` <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Cfay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ V� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: "'Ilk <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ((�� <br /> Septic Tank: Distance from nearest well_____Sa____.Distance from foundation-------l�_l---.Material-------S��.Q.X_________________-_- <br /> 1�f No. of compartments__-________, _ Ca aci D_ N " "' <br /> ------ p ty---------7- -- Size_ Q__t_.Z?X 'Liquid depth------ `7- ---------- <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 /> El 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 /> Disposal <br /> -----------------___--___------Disposal Field: Distance fro minearest well'__',O----.Distance from foundation---I-C!---------Distance to nearest lot line------4'_____ <br /> Number oflines----------L---------------------Length of each line--------- -----------Width of trench-------P__ _`�----------_-_--- , <br /> Type of filter material__ ,------------Depth of filter material--------- <br /> Remodeling and/or repairing (describe):-----------(41t.- -----j-/ ------------------------------------------------------ <br /> ------------------------- <br /> ----------------------- <br /> t <br /> ------------------------------------------------------------f--------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------•-------------------------------------rk------------------------------------------------------------------------------------------------------------------------- <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 a6d regulations of the San Joaquin Local Health District. �I <br /> (Signed)------- -,------- = '= ------------------------------------------------------------------------------------------- (Owner and/or Contractor) <br /> by:----------------- ---------------------------------------------------- ------------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> �yFOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.-------�( ------!`---------- ------------------------------------------------------------ DATE--------3------ 0- ---'*_--------------- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED-------- ----------------------------------------------------------------------------- ----- DATE--------- ------- <br /> ,Alterations <br /> ' 1 4(and/or <br /> /or recommendations: ' -_ --_4f /,' `t 0- -` ----- <br /> 1—e - t - w ___________________�C__"_ <br /> ________________r - f <br /> - ----- <br /> --------------------------------__----------------------------------------------------------------------------------------_--------------------------------------------------------------__---------- <br /> ___________________________._-__________________________,______________.____________-_-______________-________________________________.______-____________-_-_______________..____..___ <br /> PERMIT No---- ________ ISSUED_______ 1- ----(Date) FINAL INSPECTION BY:_____ ( _ _ _ --- <br /> Date ---------------------------------- ti <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ES-9-2M 9-50 W-1639 Stockton, California <br />