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APPLICATION FOR SANITATION PERMIT v� I <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 /> JOBADDRESS AND LOCATION............--• --- ---- . fr.. .. •......................------_---Oh-----------------•------•-------------------------------------- <br /> ---�-- <br /> - _...�' -�► / -�`n--ems--K-----.....mf-_ � -----------_--- <br /> Owner's <br /> Name............. �_�_ __ ------ ._, ----.-� 1-I__..C�f�� _ <br /> Phone....._... <br /> _ <br /> Address---------...-•-----•-•-----�-�-�•- "_�,..... .�-... -Q t� ]'-.`Z-�R -- -;------- <br /> 1 Contractor's Name........................... s�- {.- .e�l...Ib ••F`' ---:------•-•. Phone , �i <br /> Installation will serve: Residence ❑ Apartment House ElCommercial ❑ Trailer Court ❑ Motel F] Other ❑ <br /> Number of living units: -❑ Number of bedrooms ❑ Number of baths ❑ Lot size-------------------------_------------------------......... <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Grave] ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe❑ Hardpan �! <br /> TYPE OF INSTALLATION AND SPECIFICATION a� r <br /> (No septic tank or cesspool permitted if pe , ewer is available within 200 feet.) <br /> ' Septic Tank: Distance from nearest well___ ___Distance fro oundation...-_.17,-__.:Pellaterial_-_- ____ _�...�.____. <br /> No. of compartments..............2......Capacity------ Liquid depth---_ ._.--.......... ' <br /> y Cesspool: Distance'from nearest well--__--_--._•__-Distance from foundation_______________._----Lining,ma+erial._._._ _.___.-----_-_... :_.___. <br /> ❑ Size: Diameter......-.............................Depth----------• ..............-...................... <br /> Privy: Distance from nearest we4i.................................................Distance from nearest building_---_--_-.---.-____-_•__-._ -_ ._.... <br /> ❑ Distance to nearest lotrline.................. <br /> Seepage Pit: Distance to nearest well___.---_•_-----__-_.Distance from foundation....................Distance to nearest lot line....... <br /> � <br /> Number of pits----------------- Liming material.........--------------Size: Diameter...-__•-_--------------- <br /> Depth...__- <br /> Disposal Field: Distance from nearest Distance from foundation..... ..�_._......Distance to nearest lot line---j-7--_--- <br /> Number of lines________________ _ Length of each line._ ..........Width of trench.......�r�'�.____.............. <br /> i <br /> filter ma#erial._- .1 Depth of filter material__-__--,! <br /> Type of <br /> rRemodeling and/or repairing (describe):......... .......... .........t............................................................................................................... <br /> t ° t <br /> �y - <br /> ••-•--•-•-• ••--- -•------- ----------•-•. <br /> - ----------- ---- _.."�__ .--.. <br /> - = 1 <br /> --•---•-----------•----------------•-----•--•---•-.._._.._..------•-••-•---.....-•---• -.... <br /> l <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 la an rules d regulations of the San Joaquin Local Health District. <br /> S� heel2 ........................__________--.---(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 /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ----•-----•-----............................................................ DATE - <br /> REVIEWED BY_--------------------_----•- ------------- ............................................................... <br /> DATE__ --•---•-----•----•--------------...---.�... <br /> % <br /> BUILDINGPERMIT ISSUED--------------------------------------------------- ........................................•------- DATE------------ - <br /> Alterations and/or recommendations:......................................-...............................................--------..................................................... <br /> _-----•-_- <br /> ..............•-...................................................................---------------.......................-------•--------,--__--.----•.._...................................... <br /> .......................................................---•-----------------------------.......................................................-------........................................................... <br /> ......................................................-....................---..............................................................-............-•••-•-•-••---•............. <br /> ..................-1-•--•------•--•--•-•••-••--------...........................................................••-.................. ------•-••-----••-•--------•----................................................ <br /> /0_...... ISSUED..... ` ....__---.Date FINAL INSPECTION BY• ..__"_-----_•----,.---. r* ` ---- -::.._ <br /> PERMIT No.__._/Q _-/ { J <br /> .� <br /> Date--------A--...,,�-------------- ------ ----------------•---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-21A 9-50 W=16.39' <br />