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i APPLICATION FOR SANITATION PERMIT a (Complete in Duplicate) I, 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. S _�1 _o_--�1- 1-- � - -----��----------�------------------------------------ OB ADDRESS AND LOCA?ON__ Owner's Name------------ --- -- - �----� ------------- ---------- ----------- ------------- ---------------- -- - Phone Address--------I-----------=---C/ . ---------------------------------------•--------------- Contractor's Name--------�k�"�4`-�'------------------- Phone - --------------------------- Installation.will serve: ResidencAK Apartment„House.❑ Commercial„❑, Traile_Court.;❑.._Motel ❑ =Other ❑ f r --- Number of living units:A Number of bedrooms dumber of baths [] Lot size------------------------------- Water ________________ _ 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 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee C ' SeptTan Distance from nearest well__,�_0©-_-Distance from foundation___- .______ -- aterial >: ----` ------------------- tic No. of compartments--------------------------Capacity-----------------------Size---------------------------- Liquid ep Cesspool: Distance from nearest well________________ Distance from foundation-------------------.Lining material------------------------------------ ❑ Size: Diameter--------------------------------------Depth---•------------------------------------------------ Privy: Distance from nearest well_____________________________________-________Distance from nearest building_____-- ______________--__________ ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line-------- _____- ❑ _Size: Diameter-----------------------.De th------------------- - Number of pits material---------------------- � P �-- -- isposal Field: Distance from neares well____14 _.Distance from foundation__ _ � __-_.Dista g to nearest-lot line_ _�_ _ r. en th of each line----_ -- Width of trench_-_.-�rx--------------- umNb`er of`lines 5 l r Type of filter material____ _ �' epth of filter materiaL____1_9-______-__ n p e s '� �' ---- '- ----------- - - ----- and/or re'airing {descriV ' ------ ”- -- ,- it I hereby certify that I have prepared this application and that the work ill be done �n accrdanc with S n Jo quin County inane Sf7 I ; V.,an le re ns + a oa is ict f ---------- - ---- -- ----- - - _________________-___ _______Owner n /or Contrac Title---------------------------------------------------------------- (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 APPLICATION ACCEPTED BY------------------- - � __ DATE-------------------------------- ------------------- --- ----------- - --------------------------------------------------_ DACE _ _i _ �---------=------- k REVIEWED BY---------------------------------------- -.�..� ... BUILDING PERMIT ISSU�ED_tt--_ _ `------------ ---------------------.- '- --------- - DATE = I, Alteratio s n�rrecomendations-------------I----------- ----------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- -- �C--------------------------------------------- ------------------------------------------------- ------------------------------•---------------------..--------------------------------------------------------------------------- ------------ ----------------------------------------- ----------- ------------------------------------ PERMIT No------------------------- ISSUED-----------------------•---- -------- ---Date] FINAL INSPECTION BY:- - - --------------------- Date--------------------------- e -------•----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639