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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate} <br /> Application is hereby made to the San Joaquin Local Wealth District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance o. 54 <br /> JOB ADDRESS AND 14CATION_____ _. __�I_ ___-- <br /> ------- <br /> ------------------ ---------------- <br /> Owner's Name <br /> --- - --- --- ------- ---------- ------------------ ------- ---------------- Phone 7 4. <br /> ---------------- <br /> ----------- <br /> Aciclress_--------------- .... <br /> --- ----- ---------------- --- - --------/............ <br /> Contractor's Name--- <br /> --------------- Ph ----��p <br /> Installation will serve: esidence 2y Apartment House F Commercial <br /> - <br /> ] 0 Trailer Court [] Mote r[M] O+her ❑ <br /> Number of living units: 9"Number of bedroomsL <br /> s_�;'Lot size------- -------- ---------- <br /> 'gNumber of baths o I-—--- -------------------- <br /> Wafer Supply: Public sysfemX Community system El Private 0 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Lo'a'm [:1 Clay Loam E] Clay Ll Aclobq <br /> Hardpan 0 <br /> TYPE OF INSTALLATION AND. SPECIFICATIONS- <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic anl, Distance from nearest well-----------------Distance from foundation---------------__Material <br /> ------------ <br /> No. of compartments-------I------------------Capacity----- ---Size-------------------------------Liquid depth------ --- <br /> ---------------- <br /> C's'p,01.7 <br /> Distance from nearest well-'----,-,----------Distance from foundation--------------------Lining material <br /> El Size. Diameter--- j, ---------------I-------- <br /> -----------------------------------Depth--------- -_ <br /> Privy: <br /> -----Depth----------------------------------------------------- <br /> Privy: k.4 <br /> Distance from nearest well------------------------------------- ---------Distance from nearest building-------------------- k"14 <br /> Distance to nearest lot line ------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance 6�m foun on___/ .......Distance to nearest lot line__..�, <br /> Number of pits---- ------ !Siiameter----/� <br /> ----Lining material- Depth--- <br /> Disposal <br /> Field: Distance from nearest well-----------------Disfanc4efrom oundation--------------------Distance to nearest t' ne <br /> Number of lines----------------------•------------Length <br /> lo Ii ------------ <br /> of each line------------------------------Width of french <br /> Type of filter material____________ -----____Depth of filter mater' I__-______ <br /> -------------- <br /> TyRemodeling /or repairing (describe]:______ ------ <br /> --------------------- 60�: <br /> -----­-------------------------I----------------------------------------------------------------------- ------------------------------------------------ ------------------I-------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------_------------------ <br /> -----------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------- <br /> by i/1h I I <br /> --------------------------- --------- <br /> I hereby ify thatkhave prepared this application and that the work will be done in accordance with San Joaquin Cou n.--- <br /> �s ty <br /> e ws ru a, III <br /> ordinances, ate aws, nd/rul srand regulations of the San Joaquin Local Health District. <br /> (Signed)---- ---- <br /> ------------- ------•----------------------- --------------------------------------------------------------------------------------(Owner and/or Contractor] <br /> By:------------- - <br /> 2? Title <br /> ------------------------------------------------------------------------------------------ <br /> (Plot plans, showl g'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_____________. ---------------r---------------------------------------- DATE_________. <br /> R EVI EW ED <br /> ATE------- <br /> REVIEWED BY------------------------------ <br /> - - DATE------------------ ----------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------- -------- <br /> Alterations and/or recommendations:----------------------------------------------------------------------- <br /> ------------ --------------------------------------------------------------------------------------------------I---------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------- -------------------------------------------------------------------------------------------- --------------------------------I-----------­----------- <br /> ----------------------­---------------------------------------------------------------------------------------------------------------------------------- --------­---------- ----------------I---------------------- <br /> -------------------------------------------------------------------- — <br /> -- -----------------------------------------------------*---------------------------------------------------------7--------------------------------- <br /> PERMIT ------ ISSUED'-- - - X, P / _/ INSPECTION BY: __L/V # <br /> q1----J-----------(Date) FINAL INSPE ---------------------------------------------------------------- <br /> Date------------------------- <br /> ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ES-9-2M 9-50 W=1639 Stockton, California <br /> Q <br />