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f ,2 7a- <br /> APPLICATION FOR SANITATION PERMIT <br /> i (Complete in Duplicate) <br /> i <br /> r 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 ' 'ompliance with County Ordinance No. 549. <br /> i <br /> I[ l ?, // <br /> JOB ADDRESS AND LOCATION------100 - f -------- =-----41'------- `----------------------- ----------------------------------------------------- <br /> i <br /> Owner's�Name-------------- a` ------------------------ <br /> .! <br /> �+ ' ------- � - Phone <br /> Address-.._..- r l .I!'------17�.0------oup ------------------------------- -------------------------------------------------------------- <br /> r ---- <br /> Contractor's Name- 1°=---------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Resiaence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: F-] Number of bedrooms X Number of baths E] Lot size-------------------------------------------------------------- <br /> Water Supply: Public systIm <br /> am IV Community system ElPrivate E] <br /> ' Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobea Hardpan ❑ <br /> TYPE OF INSTALLATION' ND SPECIFICATIONS: <br /> (No septic tank or c�sspool permitted if public sewer is available within 200 feet.) ,�} 1 <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation________�p___.Material---------- ee h. �,_______. <br /> No. of�compartments-----------� •------Capacity-----K aq-------Size-------�---5 '3--------Liquid depth-------t*P------------ <br /> Ilf, <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------.______.__________- - <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- r <br /> II!' _________Distance from nearest building Privy: Distance from nearest well--------------------------------------- g------------------------------------------ <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> nf: <br /> ❑Number of pits--•----••-------------Lining material-----------------------Size: Diameter------------------------Depfh--------------------------------- <br /> ill <br /> _Disposal Field: Distance from nearest well------------------Distance from foundation_____�3 <br /> ----------Distance to nearest lot,linae_.._5-___._____ <br /> rh <br /> Number of lines_______________"�----------------Length of each line__3a__-_�oyb�t(4_=Width of trench-------�_Sl___-__-_____________._ <br /> Type of1 filter material------ _;_ 0_tk----Depth of-.filter-material°------/F___________ <br /> Remodeling and/or repairing (describe): -------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------- I!� ------------•------& ----t�5-A;/��------------------------------------•-------- <br /> - ------------------------------------------- <br /> ----------------------------------------------------------­­---------------------------------------- -------------•----------------------------------------- <br /> -----•-------------------------------------- 11------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- <br /> I hereby certify that I Ihave prepared this application and that the work will be done in accordance with San Joaquin County <br /> I ordinances, S to laws, and rule and re ula+ions f e San Joaquin Local Health District. <br /> • <br /> (Signed)..._K -= - ----- ----------------------- --- ----------- (Owner and/ar Contractor] <br /> _II' <br /> $y-------- Tale <br /> (Plot plans, showi size of t, ocation of system in relation+o wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------------------ --- DATE------------ X-3 ` ------------------- <br /> REVIEWEDBY------------------- ------------------------------------------------ '--------------------------------------- DATE---------_Z� - = ----------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------- --------------------------------------------- <br /> Alterations and/or recommendations:-----------------------•----------------- ---------------------------------- -------------------------------------------------- <br /> --------------------------------------------,:----------------------------------------------------------------------•------------ ----------------------------- ------.--------------------------------------------- <br /> ------------------------------------------1fi-----------------------------------------------------------------------------------------------------------------------•---------------------------- <br /> -------------------------- <br /> IN -------------------------------------------------------------- --------------------------------------------------------- -_-------------------------- <br /> illl - <br /> --------------------------------------------------------- ---------------- <br /> PERMIT No.---,-)-j--------- ISSUED--- --� --J' ------------(Date} FINAL INSPECTION BY:_f____-``'--------------------------------------------------- <br /> i <br /> Date----------------- <br /> f- -------------------- <br /> i � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I : <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br /> : i <br />