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97 <br /> ' - 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 /> } r�� �N`eRraw' <br /> JOB ADDRESS AN LOCATION_, .. .� _.._01f __ -----&C.t----VA(...._w,.4.IJdm- A./�I._.,�! .-----MA4--- -- � <br /> lA <br /> Owner s Name... ..... ---�"l .,--- -IS1.- .►1_ Phone j1�.`-�.- <br /> Address...........•............... <br /> .. .1_._.�//�� pp �f-. .�p�_fl.�l�Ol� p... �1 <br /> Contractor's Name.... V... ., ------>�� I�-Til t�. [[• -----�� veP�l,fit...-!�1�f1✓+------- Phone--5..l.lD...f 7.---- <br /> Installation will serve: Resident Apartment House E]* Commercial E] Trailer Court ❑`` Motel [:1 Motel E:]Number of living units: Number of bedrooms A Number of baths Rf Lot sizel��- ................... <br /> Water <br /> Water Supply: Public system ❑ Community system ❑ Private)x <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe j Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> (No septic tank or cesspool permitted if public sewer is available within 200.feet.) <br /> SepticTank: Distance from nearest w li .....Distance f m foundation.../,Z.r......10aterial-_. Cef{ I(te e <br /> •� _f 0 <br /> No. of comparhments_-.... .-_..__Capacity. �Q6N�..Size.' �i. �t____ �iquid depths ............... <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material..... .................._.._......._. <br /> ❑ Size: Diamete'r.....................................Depth.................................. --------------- ......... <br /> Distance from nearest well................................................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_.Diamete_r.._...____._._...._....Depth._..-:..::ti..._;_....__.. <br /> ........................... .- <br /> Di* l Field: T�Distance from nearest well/d0.---____.Distance from foundation <br /> ---- �-�._..._-...Distance to nearest lot line...�_c ....... <br /> Number of lines...Q�' _ _Length of each line-__ �J, ` __ /I <br /> .,� Width of trench-- -.1` ...................... <br /> T e of filter material -D T jr <br /> yp �� __kUkDepth of filter material._. i2L-_-...__ <br /> Remodeling and/or repairing (describe)-.-. . .............. ........ <br /> ......-----•... •-- -•---•--------------•........................�' ± "' <br /> - ------------ .......... <br /> f � <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 t law and rul s Ind regulations the SaVoaquin Local Health District. <br /> ISigned). ` ; �!�!�/� = 1 � (Ownerfan or Co Tractor) <br /> By: ------ F_4------ -----(Title)------- <br /> • xc�.�•� <br /> (Plot plans, s owing size of lot, location of system in lation to wells, buildings, etc., must be filed W fh th application). <br /> FOR DEPARTMENT USE ONLY <br /> A1PPLICATION ACCEPTED BY.. ..-- •••. ----------•-............ t---- �•----••-•-------•-•-• -------- DATE..) <br /> REVIEWEDBY ....--------------•-------------- •---------•-----•--- DATE Z............ <br /> ------•---------------------- <br /> BUILDING PERMIT ISSUED------------ --- -------------------------------------• --'------------•-----_... DATE---------- �t_�. <br /> Alterations and/or recommendations:. <br /> ------- <br /> ------- ------- ------------------------------------------------------•------------------------............................ <br /> ......................• --------------------- -------------------------- --•-------------------------------------------------•--------------------•- -•••----------- ........... <br /> ..................-------------------------------------------•------------............................. ............................. ----------------------- ...----------------------•.............. ................. <br /> - <br /> - <br /> ----------------:--------------•----------------•--------------•-------------------•------------------------------------------------------------- ---------------------------------------- <br /> ........................... ------------------•------••-•--------Z-o •• --............................. --- <br /> PERMIT No.._��__........ <br /> T. ISSUED............ -----------(Date) FINAL INSPECTION BY...._ <br /> t Date---------lQ ..' f <br /> +. SAN JOAQUIN LOCAL HEALTH DISTRICT I <br /> 130 South American Street <br /> 9.50 W-1634 <br /> �S­9-2MStockton, California <br /> j <br />