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�qv <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 th�work herein described. <br /> This application is made in compliance with County Ordinance No. 549. O 4 !-' O 3 <br /> 7Z 7:'E �=c✓� 61 � /J I <br /> JOB -ADDRESS AND LOCATION----A___4--- 4 --�lm_-------k_ .- <br /> --------------------------------- <br /> - _. _ oN <br /> Owner's Name---C���------ ----------------------------------------------------------------------- <br /> - ,�-------------------- Phone------ 0_07'r------------ <br /> Addre55_- '� ' ----------------------------------------------- <br /> Contractor's <br /> ------------- ---------------------------- <br /> Contractor's Name.VA1 ri___I_XAi -`fZlnr-Ill-f------------------------------------------------------------------- Phone__= sal -7----------- <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ N <br /> Number of living units: Z 'Number of bedroomsJ3 Number of baths Lot size______ <br /> Water Supply: Public system ❑ Community system ❑- Private'x ,�/ <br /> E% <br /> Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,.kT 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 compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth--------------------------- <br /> Cesspool: Distance from nearest well________________Distance from foundation------------------- Lining material___-________________-_-_---_________- <br /> ❑ Size: Diameter---------------------------------F----Dept h-_-------------------------------------------------- <br /> Privy: Distance from nearest well------------------_-----------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line________________________________________________ <br /> • ,. A*.0, a r <br /> Seepage Pit: Distance to nearest well___7-07___________Distanc from f ndation--------------------Distance to nearest lot line____,__:_________ <br /> Number of pits_.-._____=/:'�_____Lining materialKi�,l� - ize: Diameter___—W---------Depth-___�s _��5_�_3�� <br /> Disposal Field: Distance from nearest well------------------Distance frim foundation--------------------Distance to nearest lot line_____ ________ <br /> ❑ Number of lines-----------------------------------Length of each line-----------------------------.Width of french----------------------------------- <br /> Type of filter material__________ __________Depth of filter material------------------ A <br /> Remodeling and/or repairing describe :_____ <br /> -------------------------------------------------------------------" .-------------------------------------------------------------------------_�_"----------------------------------------------------------------- <br /> .. <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, Soman Joaquin Local Health District. <br /> (Signed)---- - - �---------� �_--p---------------- <br /> ------------------------------ ------ - Contractor) <br /> (Plot pI s, sh } g size of lot, location o system in relation to wells, buildings, etc., must be filed with this application). <br /> ` FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------------------- --- ----------------------------------------------- DATE-------- ry <br /> -REVIEWED BY-------------------------------------------------------- --------------------------------------- DATE--------ld / _0------" <br /> r BUILDING PERMIT ISSUED------------------------------------------------- - --------------- DATE <br /> - ---------------------------------- ------------------------------------------------- <br /> Alterations and/or recommendations----- ----------------'---------------------------------------------------------------------*-------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------­------------------------------------------------------------------------ <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> PERMIT No____ _ _ ___________ ISSUED__-_ ____________{Date) FINAL INSPECTION BY:_____�__ <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 />