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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 des ribed. This appiicafion is made in compliance with County Ordinance No. 549. .JOB ADDRESS AND LOCATION.___ ---3-3---------- ---- ------ Owner's Name----- �- -- ---------------------------------------------------------- Phone Address------2.9 7_1 �_ :��.�_ � Phone_ ` -- - 67--------- Contractor's Name_�s '= AAA- _4!_&44----` �^" ------------------------ 4 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �. Number of living units: ft Number of bedrooms [A Number of baths 0 Lot size_______ _ Water Supply: Public system [ 00' Community system ❑ Private ❑ 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 if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well---__________---Distance from foundation________ ( !1 ------. �x-�* �t_----- No. of compartments_______ -----------Capacity_____, �'_ ----Size -XMaterial------- V� -XA_---Liquid depth___�r_121--------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_---____-_______--_______ 171 Size: Diameter--------------------------------------Depth----------------------------- '.Privy: Distance from nearest well_____________________________-_-________-_____Distance from nearest building ❑ Distance to nearest lot line Seepape Pit: Distance to nearest well---------'777---Distance from foundation____Z.*__ _.Distance to nearest lot line--Z47 5C Number of pits____________--___Lining material--_��"__�--------------Size: Diameter__. _ "-----Depth_---___-P_U-- ------------ - Dispof 0,sal Field: Distance from nearest well_-- -:-----Distance from foundation_____ -----Distance to nearest lot line----- p_/_ FA Number of lines------------ Length of each line___-___. 0--------------------Width of trench-------- `! '_____________ Type of filter material-_�___ _-y-----__ Depth of filter materia____:._ Remodeling and/or repairing (describe)---------------------_--------------------- ------------------------------ _ --------------------------------------------------------------------------•--------•---------------------------------------- ----------------------------------------- I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. AA (Signed)..- ------i --- �� f_ ------------------------------------------------------ ------------- er r Contractor) . {Title) Owx� ,«arid f o ------------------------- P of plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------_ _-�_--f- _ ---------------------------------------------------- DATE___-___ __ - �/ REVIEWEDBY---------------------------------- --------------- - -- --------- - - W _U7----------------- BUILDING ------------- ------------- -------------- - DATE-------..................................................... --- --- ------------------ - - ------------------------- PERMiT ISSUED----- ----------------- ------------------- --------- DATE------- -- ------------ ---------------------------------- Aaerations and/or recommendations:-----------------------------___ y __ ---------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- CQ - ------- -- PERMIT No --7-$----- ISSUED-----__-_ ---/` ---(Date) FINAL INSPECTION BY:--------- Date -------_Dato SAN JOAQUIN LOCAL HEALTH DISTRICT F 130 South American Street Stockton, California ES-9-2M 9-50 W-1639