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3 �-9 <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> `�1� 3 S; r-tr6fcw,4 �cP !7g - Isco cq <br /> Application is hereby made tote 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 /> S � <br /> fJ <br /> -7 /A-7-- <br /> JOB <br /> .- <br /> JOB ADDRESS AND LOCATION----- -----------------��� ` � . 0"j►PPx"lrKle A � (-ztoni� S _ - ---- <br /> Owner's Name �-- <br /> ---�----- ------ ----- --------------------------------------------- Phone------------------------------------ <br /> Address-------------=---------------------------- 7-------V� d ------------------------------------------------------------------------------ W <br /> ------------------------------------------- <br /> Contractor's Name--------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , <br /> Number of living units: Z Number of bedrooms [Z Number of baths Ed Lot size----------��X____�r� __ <br /> Water Supply: Public system ❑ Community system ❑ Private 0�' <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ✓d Hardpa <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest well-----------------.Distance from foundation--------------------Material <br /> ____--_-____---------______________--_-- <br /> No. of compartments-----------/------------Capacity......3a-�fx-------Size---------------------------------Liquid depth ----------------------- - <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 Iine------------------------------------------------ <br /> i <br /> Seeps a Pit: Distance to nearest well_-__ld_d-__-___Distanceoim foundation________________ .Distance to nearest lot line----______-____ <br /> Q Number of pifs-__-_/--------------Lining ma Size: Diameter----;;!3----______--.Depth-______------------_-_-------_-- <br /> Dispos I Field: Distance from nearest well_________________Distance from foundation-------------------- <br /> Distance to nearest lot line____-_--____----_ <br /> 2 Number of lines___--/-------- - ----------------Length of each line------------ r -------- Width of french------ �r--_-----_------ <br /> Type of filter material---A�a Apth of filter material-----/-f!-(------ <br /> Remodelingand/or repairing (describe):---- ------------------- ------------ ---------------------------- - - - ------- ----------------------------------------------------------------------------------------- <br /> xf � r --------- "ca -; ----+�'TX' �--��- -.�--� <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St to I ws, nd rulesand regulations of the San Joaquin Local Health District. <br /> (Signed) Owner and or Contracfor <br /> _ ( / ) <br /> By:------------------------------------------------------------------------------------------------------------------------------------(T i f le)---------------------------------------------------------------- <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 <br /> APPLICATION ACCEPTED BY------------------- _- - DATE- -,- _-- ---- ----- <br /> --- ---------------------------------------- <br /> REVIEWEDBY----------------------------------- ------'---------------- -° :-------------------------------- DATE --- <br /> BUILDING <br /> -BUILDING PERMIT ISSUED--------------- DATES <br /> Alterations and/or recommendations:----___ +_ <br /> �+� ISS �' <br /> -------- r k----- if <br /> ---------- ------ k-------------------'-------------`--------------------------------- d er - ---- ► � ' 6----------I- - -� ---------------I- --------------------------------------------------- <br /> •---------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------------- ----------------------------------.-------------------------------------------------------------------- ---�------------------ <br /> PERMIT No._-3}_- .--__--- ISSUED------- P ------(Date) FINAL INSPECTION BY-------------w.-.- -_--- ------------------------------- <br /> Date-----------------------------T- -47/ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />