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�. ` <br /> APPLICATION FOR SANITATION PERMITC' '�"'G' '`� <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Locaf Health District for a permit to construct and install the <br /> This application is made in compliance with County Ordinance No. 549, <br /> e work herein described, <br /> JOB ADDRESS AND LOCATION_______."_�_� �' <br /> ----- ---- v 7- - �-�``` <br /> Owner's Name. :/ ~.-_ - -- AL3-G[ ! 3 <br /> 1 - <br /> ------------ <br /> ------------- ---------- <br /> w _ �r ----------- Phone__.- Q <br /> Address----- ~�`� - <br /> Contractor's Name---- Y" ------------------------n--------- <br /> ---------- <br /> Installation will serve: Residence <br /> ----------------------------------- <br /> Aparfinent House Phone -------------------------- V, <br /> Number of living units: ❑ Commercial ❑ Trailer Cour} ❑ Motel ❑ Other ❑ <br /> ❑ Number of bedrooms [- Number of baths <br /> Water Supply. public s stem Le <br /> Y ❑ Community system Lot size__-__- _-_4--X / -" <br /> ❑ Private � --------------------- <br /> Character of soil to a depth of 3 feet: Sand <br /> ❑ Gravel❑ Sandy Loam Clay Loam ❑, Clay ❑ Adobe❑ <br /> TYPE OF INSTALLATION AND SPECIFICATHardpanIONS: p -�` ❑ <br /> (No septic tank or cesspool permitted if public sewer is available within 200.feet.) ) <br /> Septic T nk: Distance from nearest well_"-_5- T <br /> _____.Distance from foundation_____`f <br /> No. of compartments ." _ -�-. --.Material_______---_- � <br /> _____Capacity `t: <br /> te <br /> Cesspool: ------.Size-- �-X-9--------------Liquid depth----- --- - ---. <br /> ❑p Distance from nearest well--- -__Distance from {ognda}ion_^- ._ -__--_ Lining material_______________" <br /> Size: Diameter------------- <br /> ---- ----- -----------Depth-------------------- _ -------------- <br /> .Priv ---------- -- <br /> ❑Y� Distance from nearest well___---±------------------------,-y•--- - - ------ <br /> Distance to nearest lot Gne__x --------Distance from nearest building- -- ------------ <br /> ------------- <br /> Seepage Pit: Distance to nearest well- ________Distance from foundation__________-_ <br /> ❑ Number of pits <br /> ---------------------Lining material------ Distance to nearest lot fine-------------___-. <br /> Disposal -ield: ..:-. -------Size: Diameter-------------------- Depth--------------------------------- . <br /> Dis}ante-from_nearest well____wpisfiance from foundation___________ _ _Distance fie nearest lot line___.___-1-C <br /> Number of lines.___ -L. , f : r <br /> Lin th of each line_ �� ! j - <br /> Type of filter material/_ �r' g Width of trench-----------�_�-rf_---s <br /> {. <br /> 2 z____!_-Depth of filter material------- �-p-'` <br /> --p-•----g•-- ---- - ------- --- .t <br /> Remodeling and/or repairing describe : _- _ <br /> ,�.� ------------ ------- <br /> ----------------------- <br /> �{ <br /> r ----erti-- that <br /> -----av ---par----------- -- ------------------------------------------------------------"-----------------------------•-------•-------------------------------- I <br /> - � i <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 reg ationso fhe San Joaquin Local Health District. <br /> (Signed)•----- ---------------- <br /> ------------------------------------------------------------------------------ <br /> By:--__--_-__ -- (Owner and/or Contractor} # <br /> i -------------- --(Title)---------------------------------------------------------------- <br /> f plans, showing size of to+, location of system'in relation to wells, buildings, etc., must be filed with this application). <br /> i FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY"___ --- x <br /> REVIEWED BY i <br /> -- ----------------------------------------------- ------ DATE---- <br /> ------- ----- --------- � <br /> BUILDING PERMIT ISSUE b - • ; - = ' "' DATE- A4 � <br /> ------------ <br /> f <br /> Alterations and/or recommendations--------------1 1 € DATE------------------- <br /> ------------- <br /> -------------•------- �. <br /> ---------------- <br /> ---------------------------- <br /> ------------------------I-----------------------I--------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------- <br /> ----------------- --------------- -----------------------I-------------------------- <br /> --------------------------------­­--------------------------------- <br /> ------------•------- <br /> -- <br /> ----------------- ---------------------------------------------------------------------- <br /> - <br /> ,---------- <br /> --------------------------- - <br /> - -------------------- ------------ <br /> PERMIT No -----__ <br /> ISSUED- --(----Date) FINAL INSPECTION B •- <br /> ---- <br /> -- ---------------------------- <br /> rr7/ 2 <br /> Date -------- - 5� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> f� <br /> 130 South American Street <br /> ES-9-2M 9.50 W4639 Stockton, California _ <br />