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APPLICATION FOR SANITATION PERMIT S all - (Complete in Duplicate) I Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Loca This application is made in compliance with County Ordinance o. 549. 6 -1------j ---- ---------- ------------------------- --------------------------- - --- -- - k ---JOB ADDRESS AND &0CA1I4N-_-_, - - Phone---------------------- -- --------- ------------- --------------------------------------------- Owner's ---Owner s Name-------- - - ---- -� - --- --------- -------------------------------------------------------------------------- Address------------- ------ -- Phone----------------------------------- Contractor's ------------------Contractor's Name---------------•----- ----------- - ------------------------- o Motel Other ❑ Commercial Trailer Court ❑ ❑ Installation will serve: Residence � Apartment House ❑ ❑ Number of living units: ] Number of bedrooms [ Numb , of baths [h Lot size---------------- ---------- --------•------ Water Supply: Public system ❑ Community system [I Private Character of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam ❑ Clay Loam El Clay E] Adobe Hardpan E] TYPE OF INSTALLATION AND-SPI=CIFICATIONS: L No septic tank or cesspool permitted if publi s�wer is available within 200 feet.) ®' sSeptic Tank: Distance from nearest well---��-___Distance fro foundation----__ _ - aerial---- ------------------------------�----- y� No. of compartments___-__ �_----------Capacity___.- �0-------Size__"-X--r1""---`Liquid depth-_-J----- ---------- Cesspool: Distance from nearest well-----------------Distance from foundation--__- --_--__-__--.Lining material----_-----__--__---._- ❑ - -------------------------------------- Size: Diameter------------- p ---------------------------------------------------- Privy: - -- -------- ------Distance from nearest building------------------------------------------- Distance ----------------------------------- ----- Privy: Distance from nearest well_________________;___- - ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well-----------------------Distance from foundation---------------_--.Distance to nearest lot line---__ _- -- 4 ❑ Number of pits----------------------Lining material_----------------------Size: Diameter---- Depth Disposal Field: Distance from nearest well;--f--0--_____Distance from foundation-_ - stance to nearest--lot-liLa��1.=- ~- ' ,y�. Number'"of'lines------7,------ -- Length of each line - �y Width of trench � �� De th of filter mate 1--- ---r_ Type of filter material- ' --- xr0'. r .•= Remodeling and/or �epairing (descri e :_- _- ------ ------ --- - ------- - •- __ 1� ter , - ---------- -- - ---- ---- ------------------ --- - ..� i d this appli #ion and +hat the work will be done in accordance with San Joaquin County hereby certify that I hag prepare ordinances, State laws, and rules and regulations of the San Joaquin ocal ealth Dist 'c _;,. [Signed]. _ /,�-'-- - ---.--- ;e ----------- - --------- Title -- ---------------------------------- ---------------- [Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed E p FOR DEPARTMENT USE ONLY -----------------=-------------- DATE--------------- •-------------------- APPLICATION- ACCEPTED BY---�----------------------------- --- -------- --- - _ _ __ -------------------------------- -- ------- ------------------------------ DATE-------- REVIEWED BY------------------------------------ -------- ---- --- -- � ------ --------- -------------- BUILDING PERMIT ISSUED-------------------------------- -- ---- -- ------------------------ DATE --------------- A----lt--e----r---a----t--i--o----n----s-- ----a---n----d----/----o- nd/or recommendations:_----�i -{--------- .ecfc lea ' ----------�"""" --9 – -- ------------ –– --------------------------------------------------- ---------------- ---- ------------------------------------------------------ ------------------------------------------------------------- INSPECTION BY: - -, ------------------- ------- Date FINAL INSP -- -------------- ------ ---- -•----------------- PERMITNo------------------------- ISSUED-------------------------------- I� � s- ---------------- 4-------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 430 South American Street Stockton, California ES-9-2M 9-50 W=1639