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I ; <br /> t 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-------X43.5-- Cater_-lQ4__RGl 'a--------------------------------------------------------------------------------------------------------- <br /> Owner's Name----- ----------------------------------------------------------------------------- Phone.-__ "�9- 96-------•------- <br /> Address-------------------2415--XatP_r'-.1 DQ--- �--------------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name------ -Tank---;5e-j_VY;L0e--------------------------------------------------------------- Phone----3.--3-95-5-------------- , <br /> t <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ® 4—cabins <br /> Number of living units: A Number of bedrooms P Number of baths [j Lot size__ _________________________________________� <br /> Water Supply: Public system ❑ Community system ❑ Private ER <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 /> Septic Tank: Distance from nearest well________________Distance from foundation--------------------Material------------------------------------------------- LA <br /> [�Xisting No. of compartments-------2-_-`-- --;---Capacity---2000--------Size-----------------------------...Liquid depth_------------------------- 1 ! <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material__________--__________---__________- <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: <br /> ----------------------- ---------------- <br /> Priv : Distance from nearest well-------------------------------------------------Distance from nearest building <br /> ❑ Distance to nearest lot line------------------------------------------------- <br /> Seepage <br /> __________________________________________ __ <br /> Seepage Pit: Distance to. nearest well --1QQ----------Distance from foundation______h� ------ to nearest lot line___3DB__ _ <br /> 12 Number of pits----------- .----------Lining ma+erial__br1 Ck______:Size. Diameter--- <br /> Disposal Field: Distance from nearest well_.:_1:00=__.Distance from foundation !_A!-___-___Distance to nearest lot line____________'____ <br /> .Number of lines..........1----------------------Length of each line------------r9r" ----.Width of trench------& _ 1J <br /> • Type.of-filter material...raek----------Depth of filter ma+erial__18Y=------------ <br /> R modeling <br /> __________Remodeling and/or repairing (describe) =---r_apa.i ing--------------------------------------------------------------------------------------------------------- <br /> ---------- ---- ---•------------- - <br /> -------------- -----•------------- ------------------------------------ <br /> ______________lx_`_ ------ro f-- ___-._ !_Y______S_ PY_ .._____ Wf_b!_S ____ _l �_ ��_____»_....______.__________.-------------------.--------------------------------- <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 +he San Joaquin Local Health District. <br /> (Signed)..............De. t_ __ ept_i.c___T_Psyste <br /> Etr'VLC_ -- - ---�"- --____-------------------------------------------------(Owner and/or Contractor] <br /> Br------ 'emery_-` art hax - -- ----------------------(Title)-----Qwner�Mgr <br /> k (Plot plans, showing size.of lot, location oin a+ion to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------------------------------------------------------------------------------- DATE-------------------------------------- <br /> -------------------- <br /> REVIEWEDBY----------------------------------------•----------------------------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED------------------------------ ----------------------------------------------------------------------- DATE-------------------------------------------- -- <br /> ----------------- <br /> Alterations and/or recommendations------------------------------------------ ----------------------------------------------------------------------------------- <br /> ---------------------------- - ---------- - ---------------------------- <br /> eAP <br /> `. <br /> yt I t -�r"z:_U_)��----ems, ------------------------------------------e�en►e <br /> --------------------------------------- ------------------------------------------------=---------------------------- ---------------------------------------------------------------------------------------------- <br /> PERMIT Na3d, R--------- ISSUED------- --- / - -- ------{Date) FINAL INSPECTION BY---------------------- --------------------------------------- <br /> 1 r Date-------------- Y7-ae/------------------------------ <br /> SAN <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California . <br /> ES-9--2M 9-50 W-1539 <br />