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'APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <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--- `--------�---7--p------ <br /> --------------- -----------------•--- <br /> �') �_ //1_A.. _`- Phone------------------------------------ <br /> Owner's Name------------- ------------------- --- <br /> L!//0 / -- -- ----------------------------------------------- <br /> Address--------••---- ----- <br /> Contractor's Name--------------------------------------------------------8��--------�---------------------------------- <br /> Phone--------------------•-------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial^❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ❑ `�'' Number of baths Lot size---------- 0---x- ------------------------ <br /> Number <br /> = r <br /> � Number of living units: ' Number of bedrooms ❑ h <br /> Water Supply: Public system ❑ Community system ❑ Private 4 ( nt <br /> ' ❑ E] El [-] ❑ <br /> *J`I <br /> � Character of soil to a depth of 3 fee4: Sand ❑ Gravel Sandy Loam Clay Loam Clay Adobe Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest well---` �----_Distance fro � foundation___________________.Material_-_----___-__-----____-----_---_-- -_/----- -.`l <br /> No. of compartments-----�---------------Capacity---- <br /> d- --------Size_------.r"h 7---..Liquid depth------- - V <br /> Cesspool: Distance from nearest well_____---_'---_-_-Distance from foundation-------------------.Lining material------------------------ <br /> ❑ Size: Diameter------------------------ ------Depth--------------------- ----------------------------- <br /> Privy: Distance from nearest well_________________________________________ <br /> ---------------------------------------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-?--------------------Lining material -------Size: Diameter�er Depth Y <br /> I pisposal Field: Distance from nearest well---#e---_.Distance from foundation--��___ Distance to nearest loft line----------------- <br /> , <br /> � Number of lines________________ ----------------Length of each line-_:_____---�,�-��__-.Width of french---------- <br /> --------------------- <br /> Type of filter material-- r= .>-�--Depth of filter material--------- <br /> Remodeling and/or repairing (describe)--------------------_-- <br /> -----=----------------------=--•------------------------------•---------•----------------•------------------------------------- <br /> -------------------------------------------- <br /> ------ <br /> -----------------•-•--------------------- <br /> ---------------•------------•------------------------ ------------------------=--------------------- <br /> ----------- -----------------------------------------p----------------------------------------------------------------------------------------- ------------------------------------------ <br /> ty <br /> i hereby certify that I have re aced this application and that the work will be done in accordance with San Joaquin Coup <br /> ordinances, State laws, andrules acid regulations of +he San Joaquin Local Health District. <br /> (Signed)-.. r E --•------ ---------------------------------------------------------------(Owner and/or Contractor) <br /> ------- = ----------------------- - - (Title) <br /> ------------------------------------------------------- <br /> BY: - --- -------------------------------------- -------------------------- --- <br /> (plot plans, showing size of lot, locati 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 —-o---------------------- <br /> REVIEWEDBY----------------- ------------------------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED------------------------ ----- ----- ------------- ------------ - <br /> ----------------•-- <br /> DATE------------------------------------------------------------- <br /> • ---------------------------------------------- <br /> Alterations and/or recommendations:---•-----------•------------ ----------- •-- <br /> ----------------------------------------------- - <br /> -----•----------------------------•--------------------------------------- <br /> --------------------------- - <br /> - --------•------------------------------------------------------ •----•---- •--------------------------------------------------------------- <br /> --------------- <br /> PERMIT NoL — --- ISSUED----- -- `3 -----(Date) FINAL INSPECTION BY.-------�---- ------=--� --�---- <br /> k, . Date-------�r'F .4�- ------------------------------------------------- <br /> SAN <br /> ------------------------------------------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I <br /> { 130 South American Street <br /> Stockton, California <br /> -2M 9-50 W-1634 <br />