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v 3b <br /> 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 incompliance wit Countv Ordinance No. 549. <br /> JOB ADDRESS AN CATION ---------------------- -- --------------------- - <br /> Owner's Name---- <br /> - ------ ----------------- ---- <br /> Phone 't <br /> Addres <br /> f = j� ------- - - -------- - aL <br /> Cbtors blame-- -r F "' �".�"� --------------------- Phone " <br /> Iris - - <br /> .. fallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> �k <br /> Number of living units: Number of bedrooms2L--Uumber of baths Lot size---Ada_~____X147P--_________________ <br /> Water Supply: Public system ❑ Community system 0 Private I, <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 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material----------------------------------------________- <br /> No. of com artments--------------------------Ca Capacity _Size---_-------_______--------------Li Liquid depth---_-----------------_---- <br /> ❑ p p Y- -- - -- 9 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__________.._________________________- <br /> ❑ Sizer Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: <br /> -------------------- ----------------------------- <br /> Priv - Distance from nearest well=_:___—'______� � - _-Distance from-nearest building � " <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> f <br /> Seepage Pit: Distance to nearest well___._!F47-------Distance fror foun ation____7' __/___.Distance to nearest lot line--- <br /> ` '__.Det 1 <br /> Number of pits___-___�----------Lining material---�_�.► ______-___ -Size: Diameter__________ Depth <br /> D'ss osal Field: Distance from nearest well__; _�__Distance from foundation_____ ____ -- <br /> p _ _.____.Distance to nearest lot line___--6- ___ <br /> Number of lines____________ - '------.-Length of each line________ !`_ Width of trench_____ �� <br /> Type of filter material_ __ _Depth of filter material----_ ° _____-__ <br /> -Remodeling and/or repairing (describe)------------------ -CX1 ` -------s pj-'� ------{ - ------------------------------------- <br /> ------------------------------------------•------------------------------I--------------------------------------------------------------------------------------------------------------------------------------------------- <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 /> - ."'. <br /> (Signed) ------- - -----------------------------------------------------( /or Contractor) <br /> BY:------ -- -- ------ at •s------------------------------------------------------------------------------ Title_!�_'0 ------------------------ <br /> Plot plans, showing oof , location of system in relation to wells, buildings, etc., must be filed with this application). <br /> + <br /> ( P g Y g � <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------- ------------------ DATE ' _ <br /> REVIEWED BY----------------------------------------- ----------------------------- ° l <br /> - - ---- -------------------------- DATE---------------- -------------- ----------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:----------- ---------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- <br /> PERMIT No.�!Tn.J--_________ ISSUED____` Z 6` (Date) FINAL INSPECTION BY:4___--- ----------- <br /> --------------- <br /> Date---------------- ------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />