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APPLICATION �' ;`` <br /> FOR SANITATION;'PfERMIT <br /> (Complete in Duplicate) : <br /> F. . <br /> Application is hereby made to the San Joaquin Local Health District for a permit to nstrucf-a,nd'install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__ <br /> ------- ----------------------- <br /> e <br /> Owner's Name---------- - -------�i.'�`-'�'"-�----c-�--�-��-�------------- - - � <br /> _ _.`Phone__----------- <br /> -------------------------- <br /> Address--------•------------------------------------ 'r LAG ��. <br /> R <br /> - '----"---"------"""""'--"---"-"----""--"---"""--"-'-'-+" ----------------------------- <br /> Contractor's Name _� +4-�� -J^. �. .����/( fi <br /> Installation will serve: Residence Apartment House ❑ Commercial Pho e_____,. ____________ <br /> ❑ Trailer Court ❑ /Motel 0 Of ❑, <br /> t Number of living units. '❑ Number of bedrooms E3 Number of baths Lot size___ lt�_------ 4 <br /> ❑ l_ x '=--- <br /> PPY� -- <br /> Water Supply: Public system <br /> Community system L] Private \(� <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy"Loam ❑ Clay Loam ❑ Clay Ej__gdobs Hard an <br /> p <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu6iic sewer is available within 200 feet.) <br /> t y <br /> Septic Tank: Distance from nearest well________________Distance from foundation-------------------- i <br /> ❑ No. of compartments___________ __ - ------ <br /> ------.`Capacity-----------------------Size------------------------------•'Liquid depth-- ------I---------- <br /> ea I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------- -- <br /> ------ <br /> ❑ Size: Diameter --------------------------- -----Depth--------------------- -- - <br /> - Ii - - --- --------------- inm material--- -------- ---1 <br /> . g <br /> Privy: Disfance from nearest well_____________________" ' <br /> ------______________Distance from nearest buildin <br /> g•-- ---------------- _--------' <br /> ❑ Distance to nearest lot line______ _ <br /> Seepa Pit: Distance to nearest well__ ?f <br /> Distance from foundation-_10 ___--- Distance to nearest lot line �' <br /> Number of pits---_-�--- -�---- _Lining material---------------- {<=: <br /> ' -------Size: Diameter___------�-----------.Depfih------- -- <br /> Disposa! Field: Distance from nearest well---- <br /> s from foundation__._- Distance to nearest lot <br /> foundat <br /> ion_,-,,,------ •�" <br /> Number of line s___--"-."""_______ � " _ --�-"Length of each line______-__________" ------- . <br /> Width of trench_______________ '�-----" <br /> Type of filter material___:_����-• Depth of filter material______l$_.'! - - <br /> 1 <br /> Remodeling and/or repairing (describ )_------------- <br /> F Qom/ ---------------- ----- <br /> ------------------- ----- ------- <br /> ------------------------- <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, S law a rules and regulations of the San Joaquin Local Health District. <br /> (Signed) <br /> ----------------------------------------------------------------------------------(Owner and/or Contractor) <br /> �Y� W --- -- - - ----------------(Title) <br /> (Plot plans, showing ize of I to on of system in relation fo wells, buildings, efc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_______-___.-_�"__" �r <br /> REVIEWEDBY - Y� --------------------------------------------------- DATE----------- <br /> --- ---------- --------- -- ----- --------- -- - -- - DATE-- ------- --� �-- �---�---- ------- ' <br /> - -- - ------------------------- ------------ <br /> 1LD1NG PERMIT ISSUED-- -------- - -------- ---- ------- - ----- ----------- ----- - - ------- ------- ------------- <br /> L ,d <br /> Alter do sad/or reromm nda+ions:___-- -- ---------- ----- <br /> - ------ -- -- - <br /> --- <br /> _ -----5---- -- <br /> �n��'-�-- - ---- --- - - -- - --V H <br /> -------------------------------------------------- ---------------------------------------- <br /> ------------------ <br /> --- -------------- ------------------------------- ------- <br /> --- - -- -------- <br /> PERMIT No..----------------------- ISSUED.---_._.�_�> 3 ' -/ __(Date) FINAL INSPECTION BY: "tJ' �� `� <br /> Date <br /> ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ES-9=2M 9-5D W=1639 �� Stockton, California 4/ <br />