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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 an stall the work herein described. This application is made in compliance with Couunn.t,y Ordinance No. 549. t bed' d "2-' , �15 -1"i Zl JOB ADDRESS AN LOC TION _ - - -� _t� .,p "� ? ' [ ' _ Owner's Name____-_-_ 4�_--- F ------- Address------------ f tt a e . Ph n ------. -� ---- -� . Contractor's Name---------•------- -C------------------ - f . ----------------------------------- ----------------------=----------------------- ----- • ❑ Trailer Court ❑____Moteh❑ Other ` Installation will serve: Residence�" Apartment House ❑ Commercial ❑ Number of living units: ❑ Number of bedrooms ( Number of baths Lot size___--- , Water Supply: Public'system ❑ Community system ❑d Private Character of soil to a depth of 3 feet: Sand ❑ Gravel �" SandTLoam "'Clay Loam-E] Clay[]Adobe❑-"I ardpan " TYPE OF INSTALLATION AND SPECIFICATIONS: k (No septic tank or cesspool permitted if public sewer is available within 200 feet.], Septic T Distance from nearest well----_z� - r® � __Distance from foundation___________________Material_____ : m a ---L<-------- o. of compartments----____-� _--_-__Capacity___.�J_9-----_--Size---•_-�-��r� .---.-Liquid depth------------------------- Cesspool: Distance from nearest wel _____________ Distance from foundation material____________________________ F -__._____. S El Size: Diameter Depth------ --------------------------------------------- Privy: Distance' from nearest well_______El Distance to nearest lot Zine_____________________________ ____________________Distance from nearest building f ---------------------------------------- 'Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot fine __---_,_----•____ ❑ Number of pits----------------------Lining terial____•-----------____---Size: Diameter-----__-_-- ; -----------.Depth------------------------ �r - t � fspos ,Field: ,: Distance.from nearest well----,I;- -------------- from-foundationr--�-��--_•__.Distance to nearest-lote�ii�e Number of lines______ I f Length of each line---------- -- ---_---.Width of trench--------��-...... Type of filter material__ -__4�-��' Depth of filter material--..1."_�-�_--_- - ----------- Remodeling and/or repairing (describe ` } rf----------- .�t;"t.. � F - --------------------------------F - ------ - ------ - --- ------------- ---------------_-•-••--------------------------__ : -•--------------------- ------- " -------------------------------------- --------------------------------------------------------------------------------------------------------- ._ -----------�--------- ------ I hereby certify that I have prepared this application and that the work will be done in acco_rdance with San Joaquin Coun; ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----------•--�----;---.�--------•--`'X•_�''� �g r ----------------------- -------------------------------(Owner and/or Confracfor) ------------ gY� ------------------------------- - - ----- --------- •-• . { (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY or APPLICATION ACCEPTED 13Y-------- ---- --- ---- ------------------------------------ ----------------------------------------BY. DATE BUILDING PERMIT ISSUED------------------ ------------------------------------------------------------------------------------------ DATE---------------------------------------------------------- ----------------------------------------------------- ----------- --------- ----------- --------------------------------------- DATE------------------------- --- Alterations and/or recommendations:______-.___ -----------------------------• ------------------------------------- PERMIT No------- - -- --- "_y1S-S.0 E D=_ ------------- --_ -{Date} -F1NAL;iINSPECTION, BY --------f ---------------------- - 1--- Date---------- SAN JOAQUIN LOCAL HEALTH DISTR T 130 South American Street s ES--9-2M 9-50 W-1639 Stockton, California