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f APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> j 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------------- a-- --------1I -o R-T_j4-------F�)-4--r-TO-A ------------------------------- a <br /> ------------------------------ <br /> Owner's Name---------- -- ! <br /> - /�/ta--------------�--�---�----�-��--�--� ----- ---- - ----- -------------------------------- Phone------------------------------------ <br /> Address--------------------------- --------------------------------------------------------------------- ----------•------------------------------------------------------------------------ <br /> Contractor's Name------------------ <br /> Installation <br /> -------Installation will serve: Residence [? Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ,Number of bedroomsNumber of baths 44 Lot size_____70_ ___.,;x__4.4__ ______________ _____ 'i}{ <br /> Water Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 'Clay ❑ Adobe ® Hardpan ❑ <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--------------------Material______________________________________________- f� , <br /> ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth------------------------- i <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------_Lining material-------------------------------------- <br /> El Size: Diameter--------------------------------------Depth----------------------------------- . <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> Di stance <br /> ___________.___________________________Distance to nearest lot line________________________________________________ Y <br /> Seepage Pit: Distance to nearest well_______'~-------Dist rom o on---- -a�_------Dis a to nearest lot line-__/ ' <br /> C)---- <br /> [ Number of pits------J-------------Lining erial-_S-ei-G-4- e: Diameter----- - --_-__.Depth-----•-2- --_---------_----_ <br /> .Disposal Field: Distance from nearest well________________ ndation--------------------Distance to nearest lot line_________________ <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------------ <br /> Type of filter material_________________________Depth of filter material_____--__--______-__-__ <br /> c <br /> Remodeling and/or repairing (describe)----------------1 ------------------------------------------------------------------ ------ <br /> ----------------------------------------------------------- --------------- <br /> -------------------------=---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ! <br /> 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 nd' r lations of the San Joaquin Local Health District. _ , <br /> (Signed)--------------------- - -------- - ----------------------------------------------------------------- Owner-and/or Contractor S <br /> By:--------------------- ------------------------------------------------------------------------------------------------------------ (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 /> APPLICATION ACCEPTED BY----------- _ --b------'-------------------- ------------------------------------ --- DATE----------- __ <br /> REVIEWEDBY----------------------------------------------------------------------------------------------- ------------------ DATE--------- <br /> BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------- DATE---------------- ------------------------- <br /> Alterationsand/or recommendations--------------------•--•--- -----•---------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------•-------•------------•----------------------------------=----------------------------------------------------•----------------•------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> i ---------------------------------------------------------------- -------------------------------------------------I----------------------------------------------------- <br /> PERMIT No.7---4-7------ ISSUED----- } `5-------------(Date) FINAL INSPECTION BY------------- ----------------------------- <br /> Date------------------- <br /> ` --------------------------- <br /> Date-------------------7- 57- `�- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br /> I <br />