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age— <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> 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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION / �a1 '/2� Ji/V-T----- ---------------------------------------------------------------- <br /> Owner's Name----------C --------------- f ��€�S d � -------------- Phone------------------------------------ <br /> Address----------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name------------------------------` -Q'w`"4� G-G---------� ----- ------------ Phone = <br /> Installation will serve: Residence �r Apartment House ❑ Commercial ❑ Trailer Court,❑ Motel ❑ Other El <br /> Number .So /C -�-�' --------------- <br /> Number of living units: -❑ Number of bedrooms'a Number of baths 0 Lot size--------0----_--__.___--__-_-_. <br /> Water Supply: Public system x Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ `-M <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 foundation__f�-_-0'�_-.MateriaL------------------------ 1�� <br /> Ca acit �C1e Size- xJ CC Liquid depth --- ------No, of compartments--_.___---- ------- p y____-- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-_-----_____----.--.Lining material-_--_--__------_---_-__--____--� Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy- Distance from nearest well_______________________________-_---__-_----___--Distance from nearest building----__--_--_------_.__------___----� Distance to nearest lot line----------------------------------�------------- <br /> Seepage Pit: Distance to nearest well______________________Distance from foundation_______-_-___---___.Distance to nearest lot line---.____---Number of pits-----------------_.__Lining material------_,____._-_.------Size: Diameter-------.---------------.Depth---------------------------Dis os Field: Distance from nearest well---_-_------.Distance'from foundation----L d_0____.Distance'to nearest lot line-__---- <br /> d. <br /> Number of lines--------------�,_-_ � -------------- <br /> Length of each line_____-_ --Q---------------Width of trench----__--_- _-- <br /> Type of filter mateDepth of filter material___--_-_ <br /> Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------- -------- <br /> --------------------------------------------------------------------------------------------------------------------------------•-------.-------•-------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- <br /> ---------------- <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, an rules gulations of the San Joaquin Local Health District. <br /> f ---------------------------------------------------------------(Owner and/or Contractor) <br /> (Sign ed)-- <br /> Sy:----------------•-------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- <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 /> - ------------- ----- ----------- DATE------�--- I------`r�-------------------------- + <br /> APPLICATION ACCEPTED BY------------- ---------------------------- ----------- ---- - <br /> REVIEWEDBY---------•------------------------------------------------------------------------- ----------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-------- ---------- DATE----lo-'16-t-5-0---------------------------- <br /> Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------- --------------------------------------------------- <br /> - ---------- -------------------------- --- ---------- ------------ ------------------------- --------------------------------------------------------------------------------------------------------------------- <br /> PERMIT No------------- -------- ISSUED----------------------- <br /> - -- <br /> -------------(Date) FINAL INSPECTION BY:----t'U_--�--------------------------------------- <br /> Date---------------- 1~ — --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> y Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />