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p � i <br /> APPLICATION FOR SANITATION PERMIT E �' <br /> (Complete in Duplicate) <br /> 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'lapplicafion is made in compliance with County Ordinance No. 549. <br /> I IN <br /> JOB ADDRESS AND LOCATION �7---I- ------ VY- ,5-- ------�-- " <br /> i l , 'a p i I <br /> Owners Name----------- <br /> ..�--�----��°--------- ----�'-'-�t--=-�-------------------------------=------------------------------------------ Phone------------------------------------ <br /> Address <br /> ------------------------------- -.. <br /> Addrss--------------------------­X--V->7-------- ' --------R�---12,--------------------,------------------------------------------- ------------------- i <br /> Contractors Name______________ �/ ✓_ __- �.___ 7 <br /> pp �-----�-----�^- •-- --�- �---- � -- - ---- ---------------------------------------- Phone---- �-�-�- ------------ <br /> Installlation will serve: Residencl` IX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: [Z Number of bedrooms ;E Number of baths [A Lot size_________________________ <br /> Water Supply: Public system JA Community system [] Private ❑ <br /> Character of soil to a depth of I3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ CIay.Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑� <br /> TYPE OF INSTALLATION ANDI SPECIFICATIONS: <br /> 'I� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> - <br /> Septic Tank: Distance from nearest well_____ _Distance from foundati n:_____«______.Material.__-_��'�-�_��_���_t________ <br /> No. of compartments______--�'__________Capacity_____0_Q0- ize___ 2�_�N_�_e____Liquid depth________#_'_________ <br /> Cesspool: Distance from nearest well_________________Distance from fou dation_______________-___.Lining material______._____________________--______ <br /> Priv® Distance froer-------------------------------------Depth--------------------- ----------------------------- <br /> Size: Diameter _ <br /> y ''Im nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> yl� Distance to'nearest lot line_________________ ______________________________ <br /> Seepage Pit: Distance tollnearest weli____________`____Distance from foundation______ _±_/.Distance to nearest lot line---- i <br /> Number of pits---------/-----------Lining material---tl?IG._{(Size: Diameter-_---- ff____.Depth___A11111111""t__ _ <br /> Dis osal Field: Distance from nearest well----- "------Distance from foundation__ -10 Distance to nearest lot line-----�_�___ <br /> Number of lines--------------- ___�____________--Length of each line------- �'� <br /> �P------Width of trench ---- -- , <br /> i Type of filter maferial-LY1=-t�_8t�----Depth of filter material_______ _2--------- <br /> Rem <br /> ---� <br /> Re IIl�deling and/or repairing (describ-e):------------- - � - <br /> -------------------------------- <br /> ------- <br /> - --------------------------- <br /> ------�p------- --------- -------!------------------------------------------------------------------------------------------------------------------------------------------------------------------ - <br /> ---------------------------------------- �------------------------------ <br /> -- -------------------------------------------------------------------------------------------------------------------------------- <br /> 4 <br /> "II I hereby certify +hat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordi,nances, State laws, and rules and .egulations of the San Joaquin Local Health District. <br /> (Signed)---------------- --,--- - - - ------------ - =----------------- -----------------------(Owner and/or'Contractor) <br /> (PlotIons, showing size of lot location of s stem in relation (Ti+le)____.1 -art -rte__ <br /> By:----------------------------- ----'1 = --- <br /> ��p g it y ion to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APRICATION ACCEPTED 13 1 1 100" <br /> ------------- � DATE-------_ - ---------------- <br /> REVirWED BY rDATE _ <br /> (---------------------------------------------------- --- --------------------------------------- ------- ------------------------------------------- <br /> BUILDING <br /> - ------------------------------------ <br /> BUILDING PERMIT ISSUED--------------------- -- DATE-----------.----- <br /> Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --Al---------------------------------------------!- --------------------------------------- ------------------------------------------------------------------------------------------------------------------------- <br /> = --------- -�M----- ----------------------------------------------------- ----- — <br /> ----------------------------------------------------------------------------- ------------ <br /> 1111�h <br /> -------------------------------------------------------------------------------------------------------------------------------------- ---------- <br /> �I(------------------------------------------ 1M-------------------------------------= <br /> 1I I ..r Ip r <br /> -------------------------- <br /> PERMIT No.---` -- -5_----- ISSUED---- ----- - ---- -- -------(Dafe) .FINAL INSPECTION BY:------------- ------------------------------- <br /> Date------------------------- ------------------- <br /> 'i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> E$-9-2M 9-50 W-1639 <br />