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f <br /> :APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) . r <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 /> I 10 <br /> JOB ADDRESS AND LQ,C T1ON-----E------- -- �F A -------- Aj��r----------------------------------------------------- <br /> Owner's Name------------ + ---------------------4-6--u ------------------------------------------ Phone------------------------------------ <br /> Address----------------------------------- ---------- ---------K -------------I-------------------------------------------------------------------------------------------------------- <br /> Contractor's Name---------------1L--- KApartment <br /> �_ _.. 11 <br /> -- Phone---------------------------------- <br /> Installation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:X Number of bedrooms Number of bathsf2 Lot size______- _Gl_1 _'____ _ _ <br /> Water Supply: Public system ❑ Community system ❑ Private M0'0' <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ��-� <br /> Septi ank: Distance from nearest well___------Distance from foundation_-__±�j�r0________-Material_____ . ___-___ _______________________ <br /> No. of compartments--------A-----------Capacity----/AP0--------Size--_-'? k_-L'_:X_5'____Liquid depth---------Y-j------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____________ --------------------- <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------- -- <br /> '.Privy: Distance-from nearest well-------------------------------------------------Distance from nearest building------------------------------------_ _- <br /> ❑ Distance to nearest lot line------------------------------------------------ ; <br /> -Seepage Pit: Distance'to nearest well----------------------Distance from foundation_'__'______ ---_-_.Distance to nearest lot line_________________ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h--------------------------------- <br /> t _. Dispos Fieid: — Distance from nearest well:-. __-- Distance from foundation___t ----------Distance to nearest-I&i-ine-------- <br /> �_-__ <br /> Number of lines......... _ff___il______**_____Length of each line-100. ��- - Width of trench_______ ._________________________ <br /> Type of filter material_L�_1_fat�f'� -Depth of filter material_____ _ <br /> Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------f------------------------------------------------------------------- <br /> E <br /> ---­-----------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------_---------------------------------- <br /> 1 <br /> ---- - -------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 1 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 rule and re ul ,dons of the San Joaquin Local Health District. <br /> (Signed)-- �� --- ---------- (Owner and/or Contractor) <br /> ------------------------------------------------ Title <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). <br /> F PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------- - 4�4----- <br /> --- ------------------------------------ DATE--------- >?- ---' ------------------------ <br /> REVIEWED BY----------------------------------------------------------- --------------------------- -------------------------- DATE---------- ----------------- <br /> -- -- ---------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations----------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------•------------------------------------------ ------------ ------ --------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ ------------ ---------------------.----------- <br /> ---------------------------------------------------------------------/----------------------------------------- --------------- --- <br /> PERMIT No..Z-�U_.------- ISSUED---�-/ ' S"�----------(Date) FINAL INSPECTION BY:-------- --- ------------------------------------------------ <br /> Date <br /> ----------------------------------------------- <br /> Date------------------ ' -� ��-------------------------'--------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-21A 9-50 W-1639 <br />