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,rte_. �-�3 •i= <br /> APPLICATION FOR SANITATION PERMIT l , <br /> (Complete in Duplicate) <br /> Application is hereby made to the Sari Joaquin Local Health District for a permit to construct and install the work herein described. <br /> r. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--------- -11--N'- Hinkley ------------------------------------------------------------------------------------ <br /> Mr. and Mrs. Fred Westbrook 2-8480 <br /> Owner's Name----------- --------------•------------------------------------------------------------------------------ ----------------------------------------- 2-8480 <br /> Owner's <br /> Address------------------------5 <br /> Contractor20 N. San---Joaquin---------------------------------------------------------------------------------------------------------------- --------- <br /> 's Name__-______Delta_ <br /> j _-------------------------------------- ------------------------------------ ---------------------------- Phone----�-R3955-------------- <br /> Installation will serve: Residence [4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -P Number of bedrooms E? Number of baths d Lot size------------- __46i---x.__3.2:5-------- --- <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 [3L Hardpan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I <br /> Septic Tank: Distance from nearest well______r-.._._.Distance from foundation____8�_______ cement—brick__.Maferial_____ _____ <br /> P yl, <br /> E No. of compartments----------2-------------Ca804 Size----- -�.x X__ -----Liquid depth-------'�-------_------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_________________________________ <br /> .yv <br /> ❑ Size: Diameter---------------------------------------Depth---------------------------------------------------- <br /> Privy: <br /> --------------------------------------- - --------Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------,__________-___---- <br /> ❑ Distance to nearest lot line------------------------------------------------ ' <br /> d Seepage Pit: Distance to nearest well-----___'-----------Distance from foundation____ a__--------Distance to nearest Io Un ________5__ --_ <br /> A Number of pits--------1-----------Lining material----0�*- Ck_-_-Size: Diameter------------3---------Depth----�-§ e� <br /> _------------ ---- <br /> Disposal Field: Distance from nearest well----------------Distance from foundation----l9..........Distance to nearest lot line________.?____ " <br /> Number of lines-------1.__.___ ________Length of each line--------1.©�_____-__'____.Width of french___�'-------________________--_ <br /> .,._ Type of filter.materiel_..__ �'QDepth of filter material_18_--___________ <br /> ' Remodeling and/or repairing (describe)-------------------New- nstallatlon <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, State laws, and rules and regulations of the San Joaquin Local Health istrict. <br /> (Signed)--------------------------------------Dielta---_----------------- -- --- - ---------------------------(Owner and/or Contractor) <br /> Perr ' Warthan T�tl Omer—Mgr. <br /> B -------------- -------------------- ------ ---- -•------ - ( � e) ------------------------------ ----------------- <br /> (Plot plans, showing size of lot, location of syste in relati w Ils, buiIngs, etc., must be filed with this application). <br /> Ids <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------------------------------------------------------------- DATE--- ---- <br /> REVIEWEDBY------------------------------•- -------- ----------------------------------------------------------- DATE-------- ------------------------- ----- ----- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------.----- DATE--------------------------------------------- <br /> Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- <br /> f ____________________________________________________________________________________________________________________________________________________________________________________________________________ <br /> ------------------------------------------------------- <br /> PERMIT No. - _-- ISSUED-------- --,/!_{_f---�------(Date) FINAL INSPECTION BY:------- _��.------------------- <br /> Date-------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES—(1-2M 9-50 W=1639 <br />