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43 /x `7 <br /> APPLICATION FOR SANITATION PERMIT <br /> n Duplicate) <br /> (Complete i <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. <br /> JOB ADDRESS AND LOCATION rD ' 1� * " 9 E..K. y — ----------------------------- <br /> n �I <br /> Owner's Name - __:-N-�------- - VD 4 Phone Z_P <br /> Address --Y--- ------------------------------------------------------------------- <br /> Contractor's Name--------------•-------_-- t ,-- -- <br /> ---------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ❑ Number of bedrooms j, Number of baths Z Lot size__________ ----------------- <br /> Water Supply: Public system ❑ °C ommunity'system ❑ Privatex <br /> Character of soil to a depth of 3rfeet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑� AdobeHardpan ❑ <br /> TYPE OF INSTALLATION AND''SPECIFICATIONS: <br /> (No septic tank or cesspool plermitted if public sewer is available within 200 feet.) <br /> Se tic Tank: Distance from nearest well________Distance from foundation----4Q_---------Material------____-____-___. '/ r ______ <br /> No. of compartments__________�__________Capacity_:5' S0 _Size_____ x_r�X_��___.Lsquid depth------9_�--f0_ _ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__________--_'.____.Lining material___________.________________________- <br /> Size: Diameter--I-----------------------------------Dept h <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> ❑ Distance to nearest lot line______________________________________________ <br /> 1 # k <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation___________-__I---Distance to nearest lot line________._____-. <br /> ❑ Number of pits-__----------------Lining material-----------------------Size: Diameter------------------------Depth----------------------------.____ <br /> Dis os Field: Distance from,nearest Distance from foundation- _/4=_:......Distance to nearest lot line______s___ <br /> -- - <br /> -' Number of lines_____ _______ ______ __ __Length of each linea____________ ---Widthof trench___________2_ '________. <br /> Type of filter material__ �Depth of filter material___-___Ir _��______ <br /> Remodeling and/or repairing (describe)---=------ ------- -------- ----------------------------------------------------------- <br /> i 4 <br /> c <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, StZ11s, and rul d regulations of the San Joaquin Local Health District. <br /> (Signed)---- � : _ _ (Owner and/or Contractor) <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------------------- ---------------------------------- <br /> ------ DATE________ ------ <br /> REVIEWED BY--------------------------------------------------- <br /> - -- ------------------------- DATE--------- U . -. _----------------------------- <br /> BUILDING <br /> ------ ----------------BUILDING PERMIT ISSUED.------------------------------------------------------------------------------------------------------ DATE-------------------------------- -- <br /> - ------------------------ <br /> Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I <br /> ---------------------------------------•------------------... -----------------------------------------------------------------------_------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------ <br /> 3��� ____ ISSUED_ _ _d_ __rf_-__�4=__(Date) FINAL INSPECTION BY_____ ----PERMIT No_______________ _ ' <br /> ---------------------------------------------- <br /> Date--------------- --` ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W4639 639 <br />