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/ C <br /> APPLICATION FOR SANITATION PERMITr <br /> (Complete in Duplicate) <br /> Application is hereby made to fhe San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance'wifh County Ordinance No. 54 f <br /> JOB ADDRESS AND LOCP,,TION- --(°- ` P (_C` , <br /> -------- ---------------------------------------------- <br /> Owner's Name---- i4 i'' ------ ------------------------------------------:--------------------------------------------- Phane-L $ I <br /> Address-------------------------- <br /> Contractor's Name -------------------------------------------------------------------------------------------- ---- ----------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial x Trailer Court ❑ Mo 1 ❑ Other ❑ <br /> 1 <br /> Number of living units:.3 Number of bedrooms ❑ Number of .baths ❑ Lot size---------�___`�_��_Y__��S_•_______________________ <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ ~ <br /> Character of soil to a depth of 3 feet:: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan P ❑ ❑ Y Y ❑ Y ❑ ❑ P ❑ <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 /> ----------------------------- <br /> ❑ No. of compartments--------------------------Capacity-----------------------Size---------------•---- Liquid depfh------------------------ : <br /> Cesspool: Distance from nearest well_________________Distance from foundation-------------------- material---_ <br /> -------------------------------_.. <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> :Privy: Distance from nearest well-----------------0----------------------------Distance from nearest building--______v-S_I_____--_-----__----_. <br /> Distance to nearest lot line-----------------li___-_____-----------_____ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------.-------Distance to nearest lot line----------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- <br /> Disposal Field: Distance from nearest well-----------------.Distance from foundation--------------------Distance to nearest lot line_______--_-_____ <br /> ❑ Number of lines-----------------------------------Length of each-line----- ------------------------Width of trench----------------------------------- <br /> Type of filter materiaL_.Y--------------------Depth of filter material""_ ""------'�`` <br /> -Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------- =-----------------------•---- <br /> f <br /> ----------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------•------------------------ <br /> 1� <br /> --------------------------------------- <br /> -------------------------------------------------------------------------------- <br /> ------------------------------------------ <br /> ---------------------------------------------------- 1,t <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 rules and regulations of the San Joaquin Local Health District. <br /> oe <br /> (Signed)-- r= - ! <br /> 0morner-_ t6v ----------------------------------------------------------- (Owner and/or Contractor) <br /> By:------------------------------------ ----------------------------------------------------------------------------------(Title)------------------ -------------------------------------------- <br /> (Plot plans, showing size of lot, ation of system in relation to wells, buildings, etc:, must be filed with this application]. <br /> FOR DEPARTMENT USE ONLY , <br /> APPLICATION ACCEPTED BY----------------------------------------- - r ----------- DATE--k4-) 7'7'__/_f f'�1 <br /> Jt - -------------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------ ------------------------------------ ------ DATE <br /> BUILDING PERMIT ISSUED--------------------------------------------- ------------------------------ ------ DATE <br /> Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------- -- <br /> ---------------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------ --------------------------------------------------------------- .-___-._ L <br /> ----------------------------_------------------_------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------___________..__---------_-.._-_______------------------- -------------------------------------- <br /> '------------------------------------------------------------------------------------------------------------- <br /> PERMIT Nd _ _-___ ISSUED____-_- 71�� _________(Date) FINAL INSPECTION BY:............ <br /> ..W__ ---------------------------------------- <br /> Date-------------- ---1973--,-------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />