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- 5¢ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND �.�jOCATION_ I .J / 6� - ---- �---'- /--- /____ G Owner's Name-------- U- E - --------------- n --------- yl 1 } {� I --- ------- Contractor's Name_________zk____ ` +� �_ ------- ------ Phone- li Installation will serve: Residence `'Apartment-Hcuse�❑ Commercial ❑ Trailer Court ❑ Motel ❑ her D Number of living un i s [�� 'Number of bedrooms �L Number of baths 4 Lot size--.__&7A0 r Wafer Supply: Public system E] Community system E] Private ------------ Character of soil to a depth of 3 feet: Sand, Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK"Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Q (No septic tank or cesspool permitFed'if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-_'_________________Material_-____--____________- --------------------------- No. of compartments-------------------------CepacitY-----------------------Size--------------------------------Liquid depth,--------------------- --- Cess ----------------- Cesspool: r -�, _* { ❑ Size_ Diameter____-____ _��.-�_--_�DepthT,e 'om foundation_=_=____r _ -Lining material____________________ p Distance from nearest well.__� 4------Distant -------------- _� -------------- -------------- Privy: `Distance from nearest-well____________________________ Distance from nearest building 4 _____________ Distance r o-nearest-lot line-.------.__________________-_____--__--- = Seepage Pit: Distance-to nearest well_ks_-_--------Distance fr'mofou anon__* _ _ _- Number of pits_=( ,1 ----�^ .r' --- - 5c to nearest 151 line___,%_4-A - - Dista a =Lining material_- -- _ ize: Diameter--_ Depth -{�, Disposal Field: Distance from ` T 'o ,.___� nearest well ___'_____.___Distance from foundation____________________Distance to nearest lot line----------------- El YP n ' Number oPli;ees_ Length of each Brie"_---------------_-- T e of filter .aterial------- '} ` �. .., a.treal i o trent ____.___ r �- �.�--� ♦ Depth of filter m Remodeling and/or repairing (describe):_____ ______-- - -_---_ E r ---/-- 1 6 ------------- !1�� , CIA- -- ---------------------- 2$ --------------------__________________ ____ _.____________________________ p --------------�pp----------------------------.------------- ------•---------------•-------- hereby certify that I have Ire reT this application and that the work-will be done in accordance with San Joaquin County ordinances, St to Taws, and,rules an r ulations of the San Joa �. t �n Local Health Disfric�,� (Signed)- - r -`�`I-Y-_'L.r ------(Owneri a /or Contractor) ) Y•------4-------;--;- - -:- - -•- ------•- l��.n� -- - '�=-___-_--:-_Title_-�_ �__ • ) qtr------------------ (Plot plans; showing size of lot, location of�sys+em in relation to`wells, buildings,-etc:; must-be-file ith-this application). k - { �- FOR DEPARTMENT USE-ONLY- APPLICATION SEONLY,APPLICATION ACCEPTED BY-______.______r INN. --------- ------ - - DATh---- .� REVIEWED BY- ------�-------.�,�_--�--�- ----;- .4.. ,. r .. - ,.. . _- -- ----- ---- ----------------- ---------------------- --------- --------- DATES BUILDINGPERMIT ISSUED_ - "' `"„----y-•- - - ., --------------` --- =----------- DATE-*0------------------------ Alterations and/or recommendations_____________________________ ------------------------------------------------------------------- ------ ---------- ------------------ /� ------------------------------------- PERMIT No.__�_v-_-1-------- ISSUED---------- ------------------------i-------(Date) FINAL INSPECTION BY:.-----------------------___--- -------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9---2M 9-50 W=1639 Stockton, California