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E 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_her_ein described. This application is made in compi4nce with County Ordinance No. 549. it —G (�C►fiLrCSI�, Owner's Name _ rC�lsr�( p - GGe�ig C _ m B ADDRESS AND LOCATION: -- ----`��-__- f- � I; ----=---------- ---------------------------------:n- Phone-:-9 Address-----------------------Al- �------ Contractor's --•-Contractor's Name -:------------ ------------ Phone-------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ j Number of bedrooms ® Number of baths ❑t Lot size____L_3_ __- Wafer Supply: Public system•❑ I�Community system ❑ Private Character of soil to a depfh of 3 f let: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan'4® h TYPE OF INSTALLATION AND SPECIFICATIONS: k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) dg Septic T nk: Distance from nearest well------5__ ___Distance from foundation______ __d_'�__----Material_____t '___.A F -- [ No. of compartments___-__�---------------Capacity_fes-- J---Size_c .A__W..FU---Liquid depth-----------------_------- -. Cesspool: Distance from nearest well-----------------Distance from foundation______'____--_____.Lining material___--_____---___-_-____-_____ ' . r — ,...�, .- ❑ Size: Diameter-11---- ------------------------Depth-------------- :--------------------------------- Y `earest well_______________ Distance from nearest building Priv Distance from n Distance to nearest lot line---------__•-------------- ---------------------- See a Pit: Distance to nea� F p g rest well--------l�__6--------Distance from foundation_____' �L___._-Distance to nearest lot line_____._______ i IT Number of pits:-'-------I-__________Lining material,2 �li/aize: Diameter____ _ _____ .Depth_______-1_-R------------------ Disposal ________Disposal Field: Distance from nearest well________________Distance from foundation--------------------Distance,to nearest jot.line_____..__. t -----=--------Length of each line-------------------- - �..,� ❑ Number of lines Width of trench------------------------ - Type of filter material_________________________Depth of filter material----------------------- Remodeling _---_______--_________ ( `� i Remo sling and/or repairing (describe ----=--- ---------' =---------------------------------- -= ji .,: -------•--------------------•-------•------------•------------------ _-------------------------- . =------------------------- �I-----------•---------------------------------------------------------------------•------... -----------•-------------------••------------- ------------- .V • +� at I ared this ation that the work will ordinances, State laws afndh rules and regulations olfct/h�e San J Joaquin Local Health eDistrfc}n accordance with San Joaquin unty ` (Signed)----------------- , Se�!�'!1-�-- �f/` ,'f r -------------------- nerand/or Con----------------------•------------------------------ - wr) By:. -----•------------------------• ---------------- ------"-------- -'-------------- ---------------------�"`--�(Title)- == =�` ? (Plot plans, showing size of lot, location of system in relation to wells, buildings, efc., must be filed with this application). . is FOR DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY____ `" �'T' - i 71--------------------- - --------------------------------- DATE REVIEWEDBY------------------------------------ ----------------------------------------------------------------------- DATE ----------------- BUILDING PERMIT ISSUED--------------'----------------•----------------------------------------------------------------------- DATE Alterations and/or recommenda#ions_________________ i M --------------------------------------------------------- -------•--------------------------------------------------- ---------------------------------------- -------------------------------------------------------------'h--- --------- ---- ----------------------------------------- PERMIT -_L--____(Date) FINAL INSPECTION BY:.______ R ►� Date. - - ------ -'---- I ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street k` Stockton, California ES-9-2M 9-50 Wd639 `