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APPLICATION FOR SANITATION PERMIT y <br /> (Complete in Duplicate) <br /> is ereby d <br /> This application is made in to the San Joaquin-Local Health District-for.a permit to construct A install the work b.erein described. <br /> hmade Application compliance with County ordinance No. 549 -------- <br /> ------------------------------------------ <br /> --------- ----__7------------------------------------------- ------- <br /> JOB ADDRESS AND LOCATION____-_------------- - ----- � ek�------------------------------------------- Phone---------------------------- <br /> _T - <br /> 6�?_ -14 ---------------------------------- <br /> owner's Name------ -------------------- ---ci S. I ------------------------------- <br /> ��2 0( ---------------- --------------------------------------------- <br /> ­_ _�--------------- Phone----- ------------ <br /> Address----------------------------------------------------- I ------------- --------------------------------- <br /> Contractor's Name_----------------------------------V. Commercial El Trailer Court 0 Motel E] other E] <br /> Installation will serve- Residence 6 Apartment House D Comm Lot size----------- 6_�--------------------------- <br /> Number of living units: T Number of bedroom, t Number of baths 0 1 <br /> Water Supply-- Public system ;_*,�C. <br /> Community system 0 Private 0 Clay Loam ❑ Clay ❑ Adobe 2!� Hardpan 0 <br /> Character of soil to a depth of 3 feet:I Sand 0 Gravel El Sandy Loam 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: sewer is available within 200 feet.) <br /> permitted if public -------r--------- <br /> [No septic tank or cesspool Per 11__77777�---Distance frkn foundation L -,_Material-------M epth--------- ----------- <br /> -arest we sill---- --- ----Liquid depth---------------------- <br /> SeptiSep <br /> c �,nk: Distance from nearest - ----------------- ----------\ I <br /> of compartments_____________------------Capac;ty-— Li I ning material-------------------------------------- <br /> No. Distance from foundation-------------------- <br /> cesspool: Distance from nearest well______________-----------Dept- h---------------------------------------------------- <br /> Size: Diameter-------------- ---- -- ---- Distance from nearest building--.---------- <br /> -------------- ----- % <br /> Distance from nearest well----------------------- <br /> - <br /> ell------------------------ <br /> Privy: Distance to nearest lot line----------------------------------""-------- Distance to nearest lot line--------- <br /> from fo,�nd,fi I <br /> on <br /> Distance Diameter-__"_------------------ ------------- <br /> Distance to nearest well-------------- : -----------------DeP'h---------------- 1.5 1 <br /> Seepage Pit: Lining material----------------iv_� ----`� -----�❑ of pits---------------------- from foundation__-----:_2---4?--------Distance to nearest lot,11ine <br /> nearest well.....!!:!�___.Disfance -------;2---------------------------- <br /> 7 <br /> 5 Width.of trenc <br /> rte. isposal _,4L_ <br /> Numlines-------------- tK ....j <br /> ber V ---------/---- filter material ------ <br /> I----Depth of fi�t ------- <br /> Type of filter mate -.,7-------- k t - - - _ _- --------- <br /> ---------- ----------Y_ .4----------------- <br /> ribe):------------- ....... -- -------- - ------------------ ----- <br /> repairing (describe):_ ----- <br /> -P �:Inq:xj or I - ------ <br /> - --------- ------- ......P --------Xe <br /> ,emod <br /> 16e,',7t---- _/ ---------------- <br /> ----------- <br /> - - ----------A- ------------ ------------------ <br /> -- -- ------------------- ----------------- S <br /> ----------? ----------------- <br /> ------ -------- ----------- ----------------------------- with ce. in accordance wit San Joaquin County <br /> d that at the work will be done <br /> repared this application an Joaquin Local Health District. <br /> I hereby certify that I have P of the San J0 <br /> ordinances, State laws, and rules and regulations of the San <br /> / (Owner and/or Contractorl <br /> ------------- ---------------------------------------- <br /> ----------- ------------------------ <br /> (Signed) I ------------------------------------------------------------------(Title) <br /> - ------ --- ------- -- <br /> By:---------------------------------------c.-ati-an-_of-_system-in relation to wells, buildings, etc-, must be filed with this application). <br /> (Plot plans, showing size of 10f, 10 <br /> 0 PART MENT USE ONLY <br /> ---------------------- DATE---- <br /> - - -------------- <br /> -_--_-1-------------------- -- ---------;---------------2 <br /> --- DATE----------------------------------------------------------------------------------------------- <br /> - <br /> APPLICATION ACCEPTED BY----------------------- <br /> V----------------------- -- ----------- <br /> -------------------- -------------- ---------------- <br /> REVIEWEDBy------------------------------------------------------- DATE - <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------------- <br /> recommendations <br /> Alterations and/or <br /> -------I--------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- <br /> ------ -------------------------------------------------------------------------------------------------------- ------I---- <br /> ------------------ <br /> -------------------- <br /> ----------------------------------- --- -------------------------------------- --- -------------- <br /> ISSUED---- ----- -- --- --- ----------- ------ <br /> PERMIT <br /> --------(Date) FINAL INSPECTION BY <br /> PERMITN'.-2-1--- --------- Date--------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> FS <br /> __9_2M 9.50 W-1639 <br />