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a � � APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 4k f —Application:is hereby-made-to•the-San Joaquin-Local.H6alth-District for-a permit to construct and•install•thework-herein-described. This application is made in compliance with County Ordinance No: 549. ! _JOB ADDRESS AND O TION- �------------ � �� -- -----=-- , ----____ Phone--------------------1- c=.- --Owner's Name--- Address----------!------------t� ��['r ---------------- ----- ----- 1 - --- ------- Contractor's Name €� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Otthher ❑ 01 Number of living units: Number of bedrooms._ dumber of baths Lot size-___' __ _ ICT_ _________________________ 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: I (No-septic tank or cesspool permitted if public sewer is available within 200 feet.) ' I II El Septic Tank: Distance from nearest well_________________Distan�e from foundation--------------------Material-----------------------?------------------------ . �l ❑ No. of compartments--------------------------Capacity-----------------------Size------I------------------------Liquid depth------------------ Cesspool:/ Distance from nearest well=-------�W- DistaiKce f11Vrom foundation_________!________.Lining material_____.___'_______________________ - ❑r �t Size: Diameter--------------------------------------Dept h-------------------------------------------------- 5 Privy: Distance from nearest well------------------------------I-____._---___-_._-_Distance from nearest building------------------------------------------ El Distance to nearest lot line.v.____-----------------------ff ____ ' � -------------- Seepage'Pit:� Distance to nearest well------/---_----_-__Distance from foundation--------------------Distance to nearest lot line____________----- Number of pitLiningmaterial t>= ------------_---Size: Diameter--_----------____------.Depth------'------------------------- .Dis .Disposal Field: Distance from nearest weld _ __Distance from foundation_ __ Distance to nearest of line_-�_-__.-_-__ p � -------- }of each IinFe_ !__ ____ Width of trench--Z/ __rf Number of lines___Q�f�_._ _. Len th' _______ ---------- Type of filter material_ -_ it'/ ,iD`epth offilter material__''__ _.________ ` �1 y 1 Remodelling and/or repairing (describe):____-_____ ___ # " 1 4 - _ -: ----- - = -- orf , ,sem '- 1 j ' ; -'- ---------------------------------------- I------- /-------------------------------- ------------------ =� hereby erci I that I have prepare i application and that the work will be done in accordance:with San Joaquin County ordinances, State la' s, nd rul and gula ' ns of the San oa qu'uZ Local Health District. ; 1 Si ned ---- ss � -- ---- e_ t� weer end Con . cfor} BY� ;---! ---------- ------ - -- -. AL�°��- ; (Title} (Plot plans,!s w' e o lot, location of system in relati n to wells, buildings, etc., must be tiled application}. FOR DEPARTMENT USE ONLYAPPLICAT RI=VIEWEDI BY_-ACCI=PTSD BY------- ---- �-----------•---------- --------- ---- - ---------------------- DATE--�----------------------�-------------------------- -------------------------- --------------- ------------ -------------- ATE--- = i ---=------------------------------------- BUILDING PERMIT ISSUED.------------------------------------------------------------------------------------------------- DATE-- '- Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------`�'i--------------------------------------------------- -- {A--- ----------- -- --- - ----------------------------------------------------- .------------------------- I - ` -- -- - - ----------------- -- ----------------------------------------- ------------------------ --------------- --------------- -- - -------------------------- ---------------------- ------------------------------------------------------------------------d�i -- -------------------- ----- -- -- ------------------ 1 PERMIT No Q -- ____ ISSUED____f`-_: -_ - (Dated -FINAL—'1NSPECTION"8Y <_`_W — Date ---------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton,California ES-9--2M 9-50 W-1839