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30 <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate] <br /> Application is hereby.made to the San Joaquin Local Health Districf for a Permit to construct and install f <br /> This <br /> application is made in compliance with County Ordinance No. S49. )I he work herein described. <br /> JOB ADDRESST D TIO <br /> Owner's Na e _C�--- - ----- ------------- <br /> -------------------------------------------------------------- <br /> r-f --, -----i---- ----- ­ ----- __1------ <br /> Address Na <br /> T-l-&_ ------------------------------------------------------------------------------- Phone <br /> Contractor's Name__ <br /> ----- ----- -------- <br /> ------ ----i------------ -- -- ----- -----&----------------------------- <br /> ---------- <br /> Phone <br /> AparfmentHouse ❑ Commercial---El----Trailer---CourfE] M_o_fe1 ❑ Other <br /> will serve: Residence ------------------------------- <br /> Installation <br /> Number of living units: Number of bedrooms <br /> Wafer Supply: [Z Numb afhs Lot size---- 10 <br /> Character Of' Public system E] Community system ❑[] Private <br /> soil fo a depth of 3 feet: Sand El Gravel E3 Sandy Loam E] Clay Loam M/Clay El Adobe El Hardpan F1'stw' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No septic tank or cesspool permitted if pblic <br /> Septic Distance from nearest well, <br /> ,Ta n k: f ewer is available within 200 fe <br /> ------Distance fro foundationi <br /> 19 No. Of compartments----------- ------------Capacity----2Z� <br /> Cesspool: ZOO-----Size------ -----------Li <br /> El Distance from nearest well_____ Distance from foundation--------------------Lining <br /> ------- arfal--- --------- <br /> ---- -- qui �ep - ------------------------ <br /> 'Privy: Size: Diameter________________" <br /> ----------- ------ <br /> iameter---------------- --------------------Depth---------------------------- material_------------------------------------- <br /> Distance from nearest well - ------------------------ <br /> El Distance to nearest lot line----------------------------------------------------Distance from nearest build;ng <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line <br /> 0 Number of pits----__"-_------ <br /> L�'n ji n g material------------------"_---Size:S;ze: DiameterDepth_________________ <br /> ----------------- <br /> Dispo I Field: Distance from nearest well 07 1----------------------Depth--------------------------- <br /> ------Distance to nearest <br /> 21 Number of lines____""-" <br /> - -----Distance from foundation <br /> Type of filter materia if--- -------- Length of each line"--------------- Width of french------ <br /> ...j <br /> ___�t. . ....... epfh of filter material <br /> Remodeling and/or repairing (describe): <br /> --------------------------------------I-----------------------------I-----I-----------------------------------------------I---------------------------------------------------I----------------------- <br /> -----------­-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------- ------ <br /> ------- -- ---- - ---- <br /> I hereby certify that I have prepared this application and that-the <br /> ( _ . ----------- 4 <br /> work <br /> ork wi11 be done in <br /> accordance- - --__with <br /> - __S,an J------------------------------------------- <br /> ordinances, <br /> _ - __ -- __ - - - __ - -ordinances, State laws, and rules and regulafions of the San Joaquin Local Health District.I� A oaquin Co-u-nfySigned, � <br /> ----------- <br /> 'By:------------------....... -----------------------------------------------------------------(Owner and/or Contractor) <br /> -------------------------•-------------------- <br /> ------------------------I--------------------- <br /> (Plot plans, showing size of]of, location -----------------------------------------------------------(Title) <br /> of system in relation to wells, buildings, etc., must be filed with this application). I%> <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> REVIEWED <br /> DATE----- - ------------- <br /> -----------------------------------------i;-------)-------------------------------------------------------------------------- -------------------------------------------- T. <br /> - <br /> BUILDING PERMIT ISSUED------------- 't----------------------------- ----------------- DATE <br /> ---------- - <br /> -------------------------------------- �1 _�---- - <br /> Alterations and/or recommendations: -------------- DATE <br /> ---------------------------------------------------------------- ---------- <br /> QJ <br /> I-----------------------I----------------------------------- ---------------- ----- <br /> ---------------- --------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------I----------------------I---------- <br /> -------------------I- <br /> -------------------------------------------------------­----------------------------------------------------------------------- --------- <br /> I. <br /> -------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------I--------------------------------------------------------------------------------------------------- <br /> ------ <br /> P ------ -- ---- <br /> --- --- <br /> P -- ---------------------t---ERMIT No.- ----.-/----------ff----- <br /> - ISSU ------ ------- ------ <br /> - -------- ) AL INSPECTION BY:"____________"_"____- ------------------ <br /> z -------------- <br /> ----------- <br /> • <br /> Date 1� <br /> --------------- -------- --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> I-5-L-9-2M 9-56 W-1639 Stockton. 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