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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District construct and install the work herein described. <br /> TThis <br /> application is made in compliance w:i4fhunfy Ordinance No. 549. <br /> JOB ADDRESS AN9- <br /> .4:QCATtjDN--------- --- ;_%�;fz----------- <br /> Owner's Name-—------114-le--------- Phone_ '_ <br /> Address--------------------------- <br /> ---------------__ ------- ---- --- %-------- ----------------------------------------------------------- <br /> Contractor's Name----------------- o---9__`---- <br /> Installation will serve: Residence Apartment House [:] Commercial E] Trailer Court E] Motel ❑ Other E] <br /> Number of livingResidence <br /> of bedrooms P Number of baths Vn Lot ---------- <br /> Water Supply: Public system )( Community system E] Private F-1 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy foam E] Clay Loam El Clay El Adobe Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank: Distance from nearest well_ ---Distance fro foun �on---/40-- <br /> - -------Maferia�---NWC 9 -------------------- <br /> .. ...Ca <br /> 47 - <br /> p;z !!�-� cla� <br /> No. of compartments_` <br /> . depth_47.0-_`/_---------- <br /> Cesspool: Distance from nearest well-----------------Distance from founclation--------------------Lining material__________ ________.____. <br /> El Size: Diameter-:------------------------------------Depth----------- ---------------------------------------- <br /> --Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line_______________________________________________ t <br /> f j <br /> Seepage <br /> ine------------------------------------------------ <br /> Seege Pit: Distance to nearest well---- ----Distance from foundation---1151111D--------Distance to nearest lq� line- ------ <br /> Number of pits---44 -----Lining Diameter---Sj3--'--------D e pf h ------------------- <br /> a T <br /> Disposal Field- Distance from nearest well--------........Distance from foundation-j?........ '.Distance to nearest lot line--- _*---------- <br /> Number of lines 0. MP—- --------Length of each line- Width of french- -ff--------------- <br /> [ <br /> 49 <br /> Type of filter ma-teria- Depth of fi+er material__1--.e----------- <br /> 1611-material.___ <br /> -Remodeling and/or repairing (describe):-- ------- - - --------- ------ ---------------------- <br /> --------- ---:-_� <br /> ---------------------------------------------------------------------- ------- ----- <br /> ?------------------- - ------- ----------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- <br /> I hereby certify that I have p:,edparreed rii <br /> g J�!qapplication and that the work will be done in accordance with San Joaquin County <br /> ordinances, S+af 5g, and rules and re -a ns of the San Joaquip_�ocal Health District. <br /> A <br /> .... ..... ...... .. . <br /> . .... ---- ---- -- D C n ac r <br /> (Signed)--------------- ---------------A7-j--!---- ---- A -----R, ---- --- A ff-,5........... wner an o C tr to ) <br /> (0 <br /> By:--------------------- --- --- -- -------- --------- - -- -- -------- ------------------------(Title)------- ................. . .....buildings, etc., must be filed application). <br /> (Plot plans, showing size of lot, location of system in re[at eo:n to wells, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_______ -- ----------------------------- ----------------------------------------- DATE--- <br /> REVIEWED BY-------------------------------- -- -------------------------- DATE------- <br /> ---------------------------------------- <br /> BUILDING <br /> ATE------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------- <br /> Alterations <br /> ATE---------------Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------- ------ -------------------------------------- ------------------------------------------------------------------------------------------------------------- <br /> PERMIT ISSUED-------- --------4"__ -------(Date) FINAL INSPECTION BY:------ ---Il-_--A/j -------------------------------- <br /> Date----------------- <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 />