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APPLICATION FOR SANITATION PERMIT g (Complefe in Duplicate) 2 i Application is hereby made fo the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in 'compliance with Co my-Ordinance No. 549. JOB ADDRESS ND LOCATION__92, , 2 -� . ---------------------------------------------------------- ----- --------------------- ---- Owner's Name ' ... - - ---------------------- -------- Phone-- Address------------- ' ---------- ---------------------- -------------------------------- ----------- Contractor's Name---- ------- ---------------------- ll.. Phone------------------------- --------------------------------------------------------- Installation will serve: Residence Y Apar men ouse ❑ Commercial ❑ Trailer Court ❑ Motel y❑r DOther ❑ Number of living units: . umber of bedrooms 4 Number of baths 12 Lot size------- C� 1 ---------- - --- -- - ---------------- Water Supply: Public system +Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M/Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wifhin 200 fee+.) Septic -ank: Distance from nearest well _ t &jW__7,4 _ Distance fro ru f i _jafionJ.0-4—, ___}____y�.� ".M Leri le__ No. of compartments___ _____ Ca acif _G__ _� _Size_f_.____ ___. _ __ p Y ==-- - iquid depth_------d---------------- ----------- 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 ]of line_______________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line.______-•_______- { Number of pits----------------------Lining material-----------------------Size: Diameter------------------- I Depth-------------------- - Dispos FieL Distance:from nearest wel ___ Distance from foundation,__.r_ __-Distance to nearest lot line_______ Number of lines_____________ c�'_____. Len fh of each line----------`� p Width of drench I °� ------------- Type of filter mate--i--- of filter material______________--_::__ Remodelin and/or repairing M g / f pairing {describe�c _ '" d = = ------------- ----y------------------- f ; ------------- ------------------------------••----------- ! --------------r-------------•------------------------ I hereby certify tha+'I li'ave prepared'+his application and'tha++he work will be done m accordance with San Joaquin County ordinances, State laws, and -pules and regulations of the' San?Joaquin Local Health Disfrict. - Si necl , --- E (Owner and/or Contractor) (Plot plans, showing size of lot, locafion of system in relafio Tide J I b -----=-------- ----- --- ----- ------- -- - ---- ----- - - -- fo wefts, buildings, etc., must be filed with this application): -11011 DEPARTMENT USE ONLY--- APPLICATION NLY --APPLICATION ACCEPTED BY---- ----------------- --- - - ------------------------------------------------------------ DATE_ ED B 1 � { Y----------I---------------------------- DATE--- BUILDING PERMIT ISSUED ------------------- ----------- DATE Alterations and/or recommendations: 1 I< --------------- -•----------------------- - . --------------------- -----------t-------------- I f - ------ -------------------------------------- ---------•----------- ------------ ----------------•-----ro-- ..---•------------ - G --------- ------ ------------------------- ---------------- PERMIT ----- -- PERMIT No._ ----�C_ 15SU1=D_-_ "-. ---_---(Date) FINAL INSPECTION BY:--------- L _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9—•2M 4-50 W-1634 � -