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APPLICATION FOR SANITATION PERMIT <br /> � O. • (Complete in Duplicate) <br /> o�9iw+� District fora er to construct an nstall e work herein described. <br /> Application is hereby made to the San Joaquin Local H alt! D p <br /> This application is made in compliance it Count Ordinance No. 549. <br /> S - r l�_.---------•-- <br /> JOB ADDRESS AND LOCATION............. Phone...._.....--•------ - ------- <br /> Owner's Name-- �• �- .... ••------- <br /> - - <br /> - <br /> Address_-._._-...----•--------•------•-•---------------------------......_...._-----•-'-------...------------.-. ----------......---"Phone--- -- --_..... <br /> Contractor's Name.... ___.._--------------_...._...------------ ..............-..... ........-----------------....--- <br /> House Commercial ❑ Trailer Court ❑ Motel ❑ Other �� 9 <br /> Installation will serve: Residence �..Apartment ❑ <br /> Lot size... <br /> Number of living units: 17 Number of bedrooms [I Number of baths = l - , Z <br /> Water Supply: Public system E] Community system C] Private ❑ l ' / <br /> Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam Cl Clay Loam❑ Clay❑ Adobep, Hardpan <br /> ' TYPE OF INSTALLATION AND SPECIFICATIONS: 1%-Z <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest well.... ... Distance from foundation,.._/0Materml.........Cl...._............ <br /> ------- <br /> _ .........X...puquid _ -Saptk: No. of compartments...... - Capactty- -f .-Size � F__ <br /> Cesspool: Distance from nearest well__............Distance from foundation...........__....Lining material-----------_--------- <br /> ------ <br /> ❑ Size: Diameter..........--------....._---_----Depth---•------------------- <br /> -f ­­ <br /> Privy: Distance from nearest well.__------.....-----_.....................Distance from nearest building...........; <br /> ❑ Distance to nearest lot line...._...__. ------------------ ' <br /> Seepage Pit: Distance to nearest well....................Distance from foundation._.................Distance to nearest lot line_-------------- <br /> ❑ Number of pits.. material..__----------•---._.Size: Diameter....-_---------------Depth__.-_.............. ..... <br /> i <br /> • Dispo I F eld: Distance from nearest well.....�.�....Distance from foundation.._/C-.---•--•Distance to nearest lot line. ---C•-•• <br /> Number of lines...._........._+e3._.. s ,Length of each lin. ........... d---�--.Width of trench_..._ Sf��.-•-------•••- <br /> Type of filter material.._.I. -�t -+-;- epth of Pit meter'usl..........� _�... <br /> 01 <br /> Remodeling cod/or repairing (descLibe):....-.cf '..+':-•....... ..- <br /> - 01-(fin e"F -•- - - <br /> ........................hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> I <br /> 1 <br /> ordinances, State laws, and rules and regulations 41k, <br /> he San Joaquin Local Health Dis}ricf. <br /> b ------------------. -- .. <br /> {Owner and/or Contractor) -rr <br /> Si ned ----- <br /> ........(TiHe). --- -- - <br /> (Plot plans, s owing 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...... - --- ---------............................-- ............................ DATE...._-_�.�.��.�.------ <br /> BUILDING <br /> ------- <br /> ...._.__.... -------...... <br /> REVIEWEDBY---------•-------------------------•-------•----------------------.....----..-.. .. DATE---------.........-...-----.......----'-- -------- <br /> ........--•-----------------.....-.....--•----------....----- <br /> BUILDING PERMIT ISSUED.........._..-._-.--•• -,•-�---._--_...............__.._ <br /> ....... .......-.........................._._.•_--•------•----- <br /> Akerations and/or recommendations -_• ..___•............................... <br /> _.. <br /> - ------.............-----.••---....---......................-......... ---' _...-. _ -----......-__...............-- ---......._...-.......... <br /> _........._. ---- ---............_..-.._. <br /> ISSUED.... FINAL INSPECTION BY:.. <br /> •----•----•----------•----....---........-------- -........... <br /> _........ .... ........._............ - _ ./. -.�..� <br /> ..V-7-.------•- !r-- - (Data) _.._.._w <br /> PERMIT No... ....V.... ....................•...... <br /> • Date----------------7 ..� .-3 +......... ....... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> E$-9-2M 9.50 WA639 <br />