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APPLICATION FOR SANITATION PERMIT I y (Complete in Duplicate) Application is hereby made `-lo the San Joaquin Local Health District for a permit to construct and install the work!herein described. This application is made in :ompliance with County Ordinance No. 549. �Ip JOB ADDRESS AND LO ATION--/ - --------------------- Owners Name------- - ----------- e i 10-47 ------------------------------------------------------------------------------- - - Contractor's Name_ • - _[ -------------------------------------------------------------- Phone- Installation will serve: Residence ❑ Apartment House'V Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living unit : Number of bedrooms Number of baths Lot size-------�47 49_ _ __________________•_-� Water Supply: Public systel Community system ❑ Private ` I ' Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan El k 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__=_w``________:_____-____--_________________ ' ❑ No. of cl mpartments--------------------------Capacity-----------------------Size----------------------------- Liquid depth W Cesspool: Distance from nearest well-----------------Distance from foundation________-----------Lining material-------_11----------------------------- - ❑ Size: Diameter. -Depth----------------------------------------------------- "Privy: -------------------------------------- -"Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__ ❑ DistancelMo nearest lot line------------------------------------------------ , Seepage Pit: Distance `o nearest well_________ _________Distance from foundation_____:.a�__ _ II'' ___._.Distance to nearest lot line______ Number bf pits-._____--------Lining material---�__ ---Size: Diameter________ -f---.Depth �__ --------------------- ---D v_'_____________ a �-Distance�p _ � �- =-:Disposal Field: �4rom.neares#-well_ ______________Dis#ance from-foundation _-_ DistancetitoTnearest��ot:line -�_-___ . Number 'of lines_______________��i�•_____ __Length of each line-------- - _'-------Width of french __A Type of ��ter material---��__ !<_-Depth of filter material_-___Lc?-"-�_______ � a Remodeling and/or re (describe)--------------------------.----------------------------------------------------------------- r -------- --------------------------------------'III--------------------- f !1'--------------------------- 1111 ------------------------------------------••------------------------------------------- 11 IlU ---'-----------------------------------------------------(-------------------•_------- I by prepared ared this application and that the work will be done in accordance with San Joaquin County herecer+ify that I have 'r ordinances, State laws, and r les and' regulations of the San Joaquin Local Health District, /r E ! A I (Signed)- -- ---- ----- - ---------------------------------------- --------------- ------ ®�/or Contractor) L - --------------------------------------(Ti+le)--- - ab: --------------..-.----- OY� .:_-- - — (Plot plans, showing size of lotl location of system in relation to wells, buildings, etc., must be filed with this application). III FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____________ _ - - -- DATE----- -- - ------ --------------------------------------------------------------- REVIEWED BY-----------------------�h " ------------------------------------- DATE BUILDING PERMIT ISSUED_11------------------ -- DATE----_-_--- �I --- }j Alterations and/or recommendations:--------- - F I�. 4 �- � ------------------------------------------- --- -- ---------------------------------------------------------------------•------------------------------------------------------------- ------------ 1111 ---------------------------•-----------------------•----------------� ------------------------- �- ------------------------ ------------------------------- - --- �n------------- -- ---------------- ---illi 6 ------ --------------------------------------------------------- -- ----- PERMIT No.'2r_Y___-_-_--__ ISSUED________ ___ ' S� .__,__(Date) FINAL INSPECTION BY:_____ __ T; Date -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reet ES-9-2M 4-50 W=1639 Stockton, California