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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate} <br /> nstall the work herein described• <br /> de to the San Joaquin Local Heaith District for a permit to construct an <br /> Application is hereby ma <br /> d i <br /> 49- <br /> application is made in compliance with County Ordinance No. 5 <br /> '29 39---�-'-- t t� 5 tr e e ts_---��o_cl�to n,----��l i f_.-------------- <br /> JOB <br /> ----------- ------------------- <br /> This JOB ADDRESS AND LOCATION--i------------ - ---------------- Phone------------------------------------ <br /> Jcoba__ artnez ----- ----------------------------------------------------- --------------------------------- <br /> Owner's Name------------- �ZZC ,�ZY' 't ------------------------ <br /> 293 ._ -'- L�PY --------- Phone 8'.i9-7 <br /> Address-------------- -- ------------ ' <br /> --------- ---------- -------- <br /> Motel ❑ Other ❑ <br /> Contractor's Name-----------D--'---�-'----P�'-�`-Z�H---�--��-OT3----�---- -------`--------' <br /> Apartment House ❑ Commercial ❑ Trailer Court ❑ - <br /> t t <br /> Installation will serve: Residence � <br /> Number of'bathsl] Lot size------ �------�-------- -------- <br /> r Number of living units: Number of bedrooms ^ <br /> Water Supply: Public system & Community system ❑ Private ❑ Hard an \h]` <br /> Pp y• Clay Loam ❑. Clay ❑ Adobe� p ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y <br /> 1 � � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: `� <br /> No septic tank or cesspool permitted if public sewer is available within 20D feet.) ,, <br /> ( <br /> Distance from nearest well_�4s-----Distance from/foundation=_._ �_K _�qu}d depth-- <br /> Distance <br /> -------------- <br /> r Septic Tank: Size- T <br /> f------------Capacity-.-?-_ ' i <br /> No. of compartments-______-- _ -------------- <br /> t Cesspool: <br /> Distance from nearest well-----------------Distance from foundation-------------------- material-__------------------- <br /> ❑ Size: Diameter--------------------------------------Depth--------------- <br /> ------------------- ----------------Depth--------------- ---------- ---------------------­- ------------------- <br /> 11 <br /> -----------,. <br /> I -----------------------------------------------Distance-from nearest building g---------------------- <br /> ¢ Privy: Distance from nearest well-_' a <br /> ❑ Distance to nearest lot line---Y------------------------------------------- <br /> M <br /> �^ Distance to nearest well_----_---__---_------Distance from foundation Diameter-_ prstance toDneeppthst lot line----------------- <br /> est <br /> ----------_-- <br /> Seepage Pit: - <br /> ❑ Number of pits--7--------------------Lining material- <br /> - - ( -- <br /> Width of trench-----a- --------------- <br /> Disposal <br /> - ------ <br /> M1 Disp <br /> osal Field: Distance from nearest well�'+~'='-`�---Distance from foundation-alt-------------Distance to nearest lot ine--.,, <br /> F Number of 4ines-------------------�------------Length of each.line---._-- . -- --- ........... - <br /> `� - Depth of filter materia4_____--/_ '�--'-- <br /> Type of filter material-l__�_-_t _�------- p resent <br /> Near in s t al l'at i on, but- in Sddit'o n - ---- ------------------ --------- - <br /> Remodeling and repairing describe):__---- :7 i !or-- n ---0 1fii--_-^c_17C�__ a'aSi1-?�d--!T'_•_--------------- <br /> I; ss oo_1 zah ch ery ng sat p0 1 etor�_r� -------- - - - <br /> ' 'dee <br /> tI i s i 3 tiai�de, _8-! ]°n 3 an Cl 1�-----: ----� - <br /> iy <br /> ty <br /> -------- <br /> ty <br /> - ------------- -------------------------------------------------------------------------------------------------------------- ----------- <br /> done <br /> I hereb certify that I have prepared this applicationSand <br /> an Jothat aquinhLocalkHealltheDistrict. <br /> n accordance with San Joaqurn oun <br /> 11 ordinances, State laws, and rules and regulations of (� Contractor) <br /> rr��' _�C__ions x---Xnc�----------a----------- --'-- -----=----- -'---------------------------------- <br /> (Signed) <br /> ------- -----`F;�t ime.tar - ---- ----------=-- <br /> 5i ned D ------Pa=- • -------(Title ------------------------------------ <br /> By: <br /> ---------- -- <br /> ( 9 I------- <br /> BY= <br /> ' -------------------------------------------------- <br /> Plot plans, sh ing size of lot, location f system in relation to wells, buildings, etc., must be filed with this application). <br /> ( FOR DEPARTMENT USE ONLY <br /> - -- ----------------------------- --- <br /> DATE rU� <br /> APPLICATION ACCEPTED BY--------------------- - -------------------_-____ <br /> DATE �� - t------------------------------------------------------ <br /> - <br /> BY--------- --------------------------------------------------------------------- <br /> DATE- ------- ----------------------- -------- ------------- �-- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------- ----------------------------------- <br /> Alfierations and/or recommen atrons----------------- __________.__.--- <br /> ------------------------- <br /> --------------------- <br /> ------------------------- ---------- <br /> -------------------- <br /> ------------------- <br /> --------------------------- <br /> �� o `� <br /> - ------------------------------------- <br /> ----- Date FINAL INSPECTION BY--- t� <br /> ------------------------------------ <br /> ti PERMIT No \\� ISSUED { pate -- --- ` . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-4-2M 4-5o W-1634 <br />