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570 <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. e r <br /> JOB ADDRESS AND LOCATION__ "" -----------� � <br /> - <br /> �p ------------------- Phone-------------------- --------------- <br /> Owner's Name L- <br /> 4 __________________________________________________________________________ ' <br /> �d .� ---------------- <br /> Address----- -------- --- ----------- - -------- --------- <br /> e-- s'' ---------- Phone_ _ G --------- <br /> Contractor's Name__ -•--- - -----'6;-�'-"�'�"----- --------- ---------- ------------------- <br /> --------------- <br /> Motel Other <br /> Installation will serve: Residence ' ,� Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ ❑ <br /> Number of living units: [�] Number o� bedrooms Number of baths Lot size____-___ -`--- <br /> + i <br /> Water Supply: Public system Community system ❑ Privatex <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan <br /> A <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-1,S-0_ --Distance from foundation____ r___.Material----4r---------------- <br /> ------Size_ - X- C------Liquid depth-� 42_- --------- <br /> No, of compartments___-_______��__-_----____Capacity---- '--- - ~ `-� <br /> Cesspool: Distance from nearest well_______________ Distance from foundation--------------------Lining materia_________________-______.____- <br /> ------ <br /> s 4 -- <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------- - <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______-----__.__------------------------ <br /> ❑ Distance to nearest lot line________________________________________________ <br /> i Seepage Pit: Distance to nearest well___�__��------Distance from foundation_s;. __--___.Distance to nearest lot line-,-?_ _______. <br /> Number of pits-----�------------Lining material__ __ _Size: Diameter_--- - '`___--.Depth------2-�----------------- <br /> F <br /> I. Disposal Field: Distance from nearest we I_/�!>�__'*.Distance from foundation____/ '�-Distance to nearest lot line 2__0 ._ <br /> ., OP ---------------- <br /> Number <br /> Number of lines----------------------------- <br /> - --Length of each line_---- --- -------------Width of trench-__- _ -------------------- <br /> Type of filter material__�,^�,.___ b--Depth of filter material____ '±---- <br /> Remodeling and/or repairing (describe)------------------ - -------------- - ---------------------- --------------- ------------ <br /> - ------------- <br /> ------------------------------------------ ------ <br /> --------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------- ------ <br /> ------------ ------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and r lyes and regulations of +he San Joaquin Local Health District. l �� <br /> L <br /> (5i ned _ _r -------------------------------------------------- ------------- Contrac <br /> 9 ) , for <br /> --------------------------(Titlell ----------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, a#c., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------- ---}--� -------------------------------------- DATE - f f'} - <br /> v✓ -. I DATE--------------------------------- <br /> REVIEWEDBY---------------------------------------------------- -- - ------------------------------------------------- <br /> BUII_DING PERMIT ISSUED-------------------------------------------- - ----------------- ---- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations------------------------ ------------------------------------------------------------------ <br /> -------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------ <br /> 37 D /3 Sy Date FINAL INSPECTION BY: -- --------- <br /> PERMIT No------------------------ ISSUED------ ------------ <br /> Date------------------------3---7 �--- ;o--f------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> 1=S-9-2M 9-50 W-1639 <br />