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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> ocal Health District for a permit to construct and install the work herein described. <br /> Application is hereby made to the San Joaquin L <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-_.____.?-/�----- �- _______ <br /> � N /- --------------- Phone------=��--��----`�d-�-�---------- <br /> ------------ <br /> ---------------------------- <br /> Address <br /> ------- <br /> Owner's Name----------A--L-F-X------------- �- ................................ -------;---------------- <br /> 7_s i - ------------------------ <br /> Address_____________ ___ <br /> ------W-mss! S _ Qn� ---------------- --------------------------------- <br /> - - ------- ----- <br /> --- ----------------.---- Phone--- <br /> sName---•-----�-'--��-------�-•-v----�-D�--��---�-------=-------•--------- - --:- - --- - <br /> Commercial Trailer Court ❑ Motel ❑ Other El <br /> Installation will serve: Residence Apartment House ❑ ❑ <br /> umber of bedrooms ix Number of baths m Lot size_____/002___X---;2­2,Q------------------------ <br /> Numbe <br /> Water <br /> of living units: t NWater Supply: Public system Community system F1 Private E] <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ElSandy Loam 7] Clay Loam ❑ Clay El Adobe❑ _Hardpan E] <br /> TYPE,OF INSTALLATION AND SPECIFICATIONS, LS€�``� <br /> {No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` <br /> i Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_________________--_____________________________- <br /> No. of compartments--------------------------Capacity-----------------------Size---------------------------------Liquid depth-------------- -• - <br /> c 1, <br /> Cesspool: Distance from nearest well-----------------Distance from foundation___________________.Lining materia--------------------- <br /> ❑ Size: Diameter Depth -------- ------ ----- <br /> Privy: Distance-from nearest well----------------------------------- - <br /> --------Distance from nearest building__--_-.----- _------------------------ <br /> ❑ - , <br /> Distance to nearest lotline________________________________________ ____ <br /> p _________Distance from foundation-_.__�---------- <br /> Distance to nearest lot line___9�__--___ <br /> See a e Pit: Distance to nearest well____._ <br /> C.. Number of pits-------I-_ ------'-Lining material_._ Ec-___Size: Diameter --------.Depth ------------ <br /> 2-42nce from nearest well__ '___.Distance from foundationJ---3`7 -----Distance to nearest lot line__��___-- <br /> Di pos 1 Field: Distance <br /> Number of lines----- --------------Length of each line--------5_d----------„---.Width of trench----- ` -----------•--- <br /> Yp ------- <br /> Type of filter material-_1��___-_ a_Gk__Depth of filter materna- _ <br /> re repairing describe):------- 6_L f7 ------ f' ------ ---------/y_d7 ------ r - <br /> Remodeling and/or� p g [ <br /> �: pc/ - <br /> ------------------------------ <br /> -------------- <br /> -----------------------------------------------------=-------- --- -------------------------------- ---------------------- <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 San Joaquin Local Health District. <br /> Owner and/or Contractor) <br /> Sined) <br /> r-- 'E 4�' <br /> 9 w=_. <br /> j G'^ ----------------------- ------------- ----(Title) <br /> By:---------- <br /> (Plot`plans;showing size of lot, location,o`f system in relation to wells, buildings, etc., must be fled with this application]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCfl EPTED BY -------------- = <br /> DATE--------- ------------- <br /> 9 <br /> ! � � ------- DATE--------- --�`-�J----------------------------- <br /> REVIEWEDBY-------------------------------------------,;. ------------------------- -------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ <br /> Alterations <br /> --------------- DATE-------- -------------------------------------------------- <br /> Alterations and/or recommendations_______________________ __ ------------------------------------------------ ------------------- <br /> ----------------------------------------------------- <br /> --------------------------------- <br /> •- ------------- <br /> L _ ___________________________ ______ __ <br /> // <br /> Date <br /> PERMIT No.__3��----------- ISSUED------';1--�___-_--�-----------[Date) FINAL INSPECTION BY------------ -- -- ---- -----------)---/--/------- <br /> ----- ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> E5-9-2M 9-50 W-1639 <br />