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�y 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 o. 549. ` JOB ADDRESS AND LOCATION_ = - ------------------ Owner's Name---_ `�?'' � s"- - v � - _ /y ------- Phone Address------�------- --------------- - --_'"_"� — " Contractor's Name_-_jo_ ., -,� ,� - ----------------------------------------- '" -�� x*'.r; ------ ---------------- Phone__t1:-°�' F�. -_ ------ w Installation will serve: Residence , Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: . Number of bedrooms J21 Number of baths [ Lot size--_ [�-_ '_-f Q Water Supply: Public system Community system Private ❑ Character of soil to a depth of 3. feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Y 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--___ � --------Material-------------- - ------- ------- ------ ------ No. of compartments---------7_---_-------Capacity----19 -------Size_!. `(--I_ �p d ' ___--Liquidepth-_5��----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--___---__---_-___-.Lining material----_---_-_--____ ------------------ r El Size: Diameter--------------------------------------Depth----------------------------------------------------- Privy: Distance from nearest well--------------------------------------` -----------Distance from nearest buildin ❑ Distance.to.nearesf lot line 9 Seepae Pit: Distance to nearest well-----------------a._-Distance from foundation-----3-P-f E ` --.Distance to nearest lot line---- Number of pits---.___-_________Linin g mate ria f ��A / -_--Size: Diameter-___ .� Depth-44", - ----------- Disposal Field: Distance from nearest well-------""^ ____.Distance from foundation---2-_Q____------Distance to nearest lot line__- -I� , Number of lines__ __ �___-____ Length of each line------ p W of trench 2! Type of filter mdterial-___ At-_-_-_-De th of filter material- !$___________ • F Remodeling and/or repairing (describe):---_--- --- ' r t --------------------------------------------------------------------------------- ----------------------------- --- -------------------------------^--------------------------------------------------------------------------------------------- --------------------------------------------------- i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and-`rules and regula ions of the San Joaquin Local Health District. (Signed)_- r �' -awll/�.- � ` q�'-`�-- BY:- 45,� t (_ -� 7 7' r Contract ,.--ter. ------------------------------------------------(Title)--_/,l - ---- (Plot plans,(o_w'ng 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_________________________ ------------ ---- -- ------------------------------- ------ DATE---IEWED BY = - --- -------•------------------ ------------------------ BUILDING PERMIT ISSUED DATE `-`---- t-----5------------------------- -` ----------------------------------------------- ----------- DATE----------------------------------------------------------------------- ------------------- - - terations and/or recommendations:-------------- � - ----------- ------- - ---------------------- ----- ------------------------------------------------------------------•------ -------------------------------------- --------- ------------------------ ---------------------------------------------------------------------------------------- ------------------ ----------- - PERMIT No,___-_----- ---------- ISSUED_--- � ----5�-- ----------(Date) FINAL INSPECTION /� Date----------1 l J SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street f ES-9-2M 9-50 W=1639 Stockton, California