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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 �/ � / tel• --�,�_-------(��_��=' _ r- J��i--� JOB ADDRESS AND LOCATION-------- f �• = � - ` Phone Owners Name )=_.r- ------------ ;/� Address-_ ' � I� 1. - J '�' '� A - ---------------- Phone-- ---y-��----�--------- , Contractor's Name---------------______-_----.- -- Installation will serve: Residence`s Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: JZ Number of bedrooms Number of baths li Lot size__ l ~ ----_-_�--- --------------------- Water Supply: Public system ❑ Community system ❑ Private,K Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted i*pjbDjfc se er is available within 200 feet.) �. Distance from nearest welistance from foundation--%rp M rial.. (, _'� � Capacity __Size0_r0_ .� q p ,rte No. of compartments_/------------- -- - Li uid de th- --------_--_-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- 0 _-_--------------__---_-------_---.❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- .Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______--..-_----_ ❑ Number of pits----------------------Li ing material-----------------------Size: Diameter------------------------Depth---------------_-.-------------_- � fs. Disposal Field: Distance from nearest well--------------_Distance from foundation- __r---f-_______- Distance to nearest lot Number of lines----------- --- --- --- Length of each line-_- -'--i.-Width of french------ - -�'_:__-_------. y Ar Type of filter material---'' --------- „___-Depth of filter material___--__re�--__- Remodelin and/or repairing (describe):-_----- ----- ---------------` ------------= -------- - ----f��------------ - ----- aj r --- ----------- ----------------------------------------------------------------- --------- - ._ - ----------------------------------------------•------------- ------------------------------------------------------------------------------------------ hereby certify that I e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a r es and regulations of the San J” uin Local Health District. --------- "-~• r Contractor) ----------------- BY: -------- (Title)---- (Plot plans, showin ixe of lot, location q�F system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ -- -- DATE_-__--__--_---�-___- --- - --------------------------------------- ------------------------- REVIEWEDBY --- ------ -- DATE-------------- '----------- ------M----------------- BUILDINGPERMIT ISSUED----------------------------- -------------------------------------------------- DATE------------------------------------------------------------ � lterations and/or recommendations------------------ -------- ------------------- --------------------------------------- -------------------------------- - l. .. ---------- -- ------ ----- - ----- --- ------------ - '' ---------- ------ --= ----- ---------•----------------------------------------- -------- ----------------------- PERMIT No.-----1�_ �------ ISSUED----�_-'V----<---------------(Date FINAL INSPECTION BY:--- -�- ------------------------------ Date------------------- - - - •- -- ---------------------•------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639