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APPLICATION FOR SANITATION PERMIT �M <br /> (Complete in Duplicate) �r�A A ` <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 /> J08 ADDRESS AND LOCATION © f �,, (-7- ------ - --- - ----------------- -------- <br /> Owner's Name--------------------------- ✓ -----------a /-- �•---0----- ----------- --------------------------------------------- Phone _-a -------- <br /> Address-----------------------------------------------------------}------- 1 - - - ----- ------------------------------------------------------------------------------------- <br /> Contractor's Name -----------I'-d-AD----q--I_l_-i --------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence +['Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> i <br /> Number of living units: ❑ Number of bedrooms 2-Number of baths ❑ Lot size_________ ________-___--_____ <br /> Water Supply: Public system ❑ Community system ❑ Private [vf <br /> Character of soil to`a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest well____5_0J_____Distance from foundation------f 0------Material_____________________-__- ._------______-- <br /> No. of compartments------------�"------- P y---- �1 - --Liquid depth------------------------- <br /> .Ca Capacity �P tom______Size____ __ <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----------------------_.Depth----------_---------------------- <br /> i <br /> .Dispos Field: Distance from nearest well__-_ 3--__.Distance from foundation-----/___ ........Distance to nearest lot line_____________ <br /> Number of lines------------------/--------------Length of each line------/-0-d____i_-------Width of trench---------- --- -------------- <br /> Type of filter material---- _/,�_E'�K_Depth of filter material--------Z--0-°-� <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 e­-1-7;­ <br /> nd' regul 'ons the San Joaquin Local Health District. <br /> (Signed)------------ ------- - ----- ------ ---------------------------------------------------- ----------------------------------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot <br /> y:------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY q <br /> APPLICATION ACCEPTED BY------ --------------------------------------= DATE --------------------------- <br /> REVIEWED BY-------------------- -------------------------------------------------- DATE------------------j---------------------=------- <br /> ti <br /> ------------------------------------------------------- ------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------- ------- DATE------------------- <br /> Alterations and/or recommendations----- ---------------------------------------------------------- ------------------------------------------------------ --------- -------- <br /> ------------------t d� ` `S� �� '.11',� �`--_----. ° `fie -- <br /> _ W- ---------- t&1-A-4 <br /> ,�--fie'- -e- <br /> 1„w` ---------------------------- w�.�.q..--- ' '`-w -------- <br /> 0 <br /> � <br /> '�IiS fyr+v 1, CI. •Gd O N-j�r{ b19V;S <br /> PERMIT No.---- :3 LA----------- ISSUED--- 5------- (Date) FINAL INSPECTION BY: ---K-4---U--------------------------------- <br /> Date---------------d a - <br /> ------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 Wd639 <br />