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7 <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> d install the work herein described. <br /> Application is hereby made to the San Joaquin <br /> Local Health District for a permit to construct an <br /> This application is made in compliant with County Ordinance N 44• <br /> �:.� . <br /> _ r - -------- � / <br /> JOB ADDRESS A f) L CATION _s____--_- - --- <br /> --___ Phone__e at_'^-I *- <br /> -------------------- -- <br /> Na ----•------------------------------------ <br /> `_ - -J ------------------ <br /> Address-- / - f Phone ^f <br /> Contractor's Name ---------------------------------- <br /> Commercial ❑ Trailer Court [I Motel [I Other ❑ <br /> Installation will serve: Residence ❑ Apartment House F-1 <br /> Number of living units: -0 Number of bedrooms ❑ Number of baths ❑ <br /> Lot size---------------- ------------------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private [I . Adobe E] Hardpan ElCharacter of soil to a depth of 3 feet: Sand ElGravel E] Sandy Loam ElClay Loam ❑ Clay ❑ <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 foundatiSize______-_-----_-_Material—iquid depth___.______ --- ------- <br /> ❑ No. of compartments--------------------------Capacity---------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-___________________Lining materia_____________-____-- <br /> -----Deth--- ------------------------------------------------ <br /> F1 Diameter-------------------------------- p <br /> ___________________________Qistance from nearest building________---------------------------------------------------------- <br /> Privy: Distance from nearest we41______________________ <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> Distance to nearest lot line_______________-_ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- <br /> 1-1 Number of pits--------•---•---------Lining material-----------------------Size: Diameter-----•-----------------Dept h--------------------------------- <br /> nce <br /> Disp al Field: Distance from nearest well---------------Distance <br /> from <br /> each foundation <br /> Q ation--------------------W dth oftfrench est lot line____.------------ <br /> Number of lines_________________ <br /> Depth f filter materia4_______________________ <br /> Type of filter material.__.._ .___- P 4 , <br /> ` -----------------------------------------------•-----------------•------------ <br /> Remodeling and/or repairing (describe)-____=- - , 6 " -_----- <br /> -------------------------- <br /> --•------- <br /> -------------------- <br /> -clone <br /> I hereby certify that I have prepared sal)plication <br /> lf the San Joaquin Local Health eDistr District. <br /> accordance with San Joaquin County <br /> ordinances, State laws, and rules and <br /> (Owner and/or Contractor) <br /> ( .g }Si ned _ -.-.l 4 = -------------------- <br /> ---------------------------------- <br /> Tale <br /> ------------------------- ------------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this applica- -tion . <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- - - ------- ---- --------------------------- ---------------------------------------- DA --------- <br /> REVIEWED BY----•------------------ -------- DAT ------------------ --- <br /> ------------------------------ <br /> BUILDINGPERMIT ISSUED------------------ ----------- ---------------------------- --•------------------------------------------------------------------- <br /> Alterations and/or recommendations-------------------------------------------------------------------- ---- <br /> ---------------x--7 <br /> ---------------------- X1 <br /> -------------- - -------- 1 <br /> ----------------------------t--- -p-�� !4.1�---------- " <br /> _�`z c= --------------- --------- <br /> ----------------------------------------------------------------- <br /> --------------------------- <br /> S_ --____ Date FINAL INSPECTION BY:-___-__ --- -- <br /> PERMIT No.---r7__'�-7----- ISSUED ( I 1 �a �s 3 <br /> Date-------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-56 W-1639 <br />