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! I II 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' ompliance with County Ordinance No. 549. � JOB ADDRESS AND yLOGATION--- � r�-6-------- --- ( -= Owner's Name.......0-- 1 = ��r��----------------------- ---- - -------------- Phone ------- 11. Address---------� --------------- --------------------------------------------------- •----------------------------------------------------------------------------------- Contractor's Name Phone----------------------------------- ---- Installation will serve: Res4dence Apartment House ❑ Commercial ❑ Trailer-Court ❑ Motel ❑ Other ❑ Number of living # u�n�its: .10 N er of bedrooms [�O_ Num ber of baths [7 ,Lot size---------- _______________________ Water Supply: Publics sem CommunitY°s stem ❑ Private El. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATIONIIAND SPECIFICATIONS: (No .septic tank or `esspool permitted if public sewer is available within 200 feet.) ;ISI � .x Se ti Tank: Distance from nearest well_______ ________Distance from foundation_____ C3_____---Material____________(_4.Yr'z_ `__�_________ No. of;compartments---------------" ------Capacity---------_ LJC1 Sixe-- ---.91XS-X-3------Liquid depth--------9'2r------------- Cesspool: Distance from nearest well_______ ________Distance from foundation---------------!-_.Lining material-------------------------------------- I' ` ❑ Size: Diameter----------------=-----�---------------Depth---------------------------------------------------- Privy: Distance from nearest well_________________--__________-__________________Distance from nearest building------------------------------------------ •: Seel Dlstanc Seepage Pit: Distan�e to nearest lot line------------------------------------------------ aI, p g �e to nearest well----------------------Distance from foundation------------------Distance fo nearest lot line_________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter______--_"____-` • -:-.Depth--------------------------------- - os I Field: Distance from nearest well______•-%------Distance from foundation______ID_ ___.Distance to nearest lot line_________________ ' Num4 of lines----------------_ _________t-Length of each line____7_Q__-____4A`____.Width of trench_______Y---—__-__-_____.__ Type of filter material______ rx___________Depth of filter material------ Remodeling and/or repairing (describe):__________________________________________________`----- ---------------- ---------------------u------------------------------------------------ _~------- --------------------------•------------------------------------------- --------------------------------------------------------------------------------------------------------------- I11I -------------------------•-------------------------------- hereby certify that 1 have prepay application,and that the work will be done in accordance with San Joaquin County ordinances, State , and r sand' tions of the San Joaquin Local Health District. (Signed)_�------ __-,.- _ I...... ------------------------------------------ (Owner and/or Contractor) --By---------------- --- ----- ------------------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- (Plot plans, showing size Of[ot, location of system in relation to wells, buildings, etc., must be filed with this application). pp is a► �p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- DATE----_----------- ,------ --- - REVIEWED BY �M -- --------- ------------- ' . , cS� -------------------- DATE---------------- ------------- ---------- ------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:--------------------- ------------•-------------------------------------------------------•-------•--------------- � J � -�z f '------------�-} « `.- _r v Aj t a----------------- S t ` --------------- -------------dh------------------------------------------------------------------------------------------- ----------------------------- ------ j --------------- I PERMIT No.___3_ -- --------111ISSUED___9--- --`--------- --------(Date) FINAL INSPECTION BY:.-. _------ ----------------)------------- Date---------------- ---_------Date---------------- ------------------------------------------------------------ V . I SAN JOAQUIN LOCAL HEALTH DISTRICT �'"� •� 130 South American Street $ Stockton, California ES-9-2M 9-50 W-46,39 I