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APPLICATION FOR SANITATION PERMIT t� (Complete in Duplicate) l/ Application is hereby made to the San Joaquin Local Health District for a permit to constM he work herein described. This application is made in compliance with County Ordinance No. 549. - �r. JOB ADDRESS AND CATION f---------. � ! � `�-a Owner's Name------- Q ---------------- (-_ ti.tc4l f- l----------- Phone�8 -s �� - Addressf ---- ! - d-----------#A#A I ~" Contractor's Name__ r ¢----- --`-- ---- -�4_ _1 (S _"---- -= 1P 11 $--� ' -'-------------- Phone--fes ,1 4'p Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I/ Number of bedrooms Number of baths Vj Lot size--%-5 __Y----f,�S _____________________ Water Supply: Public system ❑ Community system �RL Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W,Hardpan ❑ V TYPE OF INSTALLATION AND SPECIFICATIONS: �K (No septic tank or cesspool permitted if public sewer is available within 200 feet.) O r I Septic Tank: Distance from nearest well r-_---_-___Distance___Distance from found/ation _/D____--___ Material_Ug-a ____________________" q No. of compartments ____ O_____Capacity__ _fft_Size_ ___ q p J p �ie_v _-- _ _ _X �a__ _�s Liquid depth -=_.- =-==-"• -Cesspool: Distance from nearest well------------------Distance from foundation______`__ Lining material______"---------___-__-_____----__-- ❑ Size: Diameter---------------------------------------Depth--------------- ------------------------------------- ..� 'Privy: Distance from nearest well---------------------- _________I-_-___-____---Distance from nearest building----------------------------------------- I ❑ Distance to nearest lot line__'___________________ __ ___ ___ __ _ ______ _ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--------------- ❑ Number of pits----------------------- Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- ff Dis oral Field: Distance from nearest well__ '•___Distance_from foundation__ ___ ! Distance to nearest�ot-line_" 4 �- �/ --- ------- Number of lines______ _ _ - -- __Length of each line___ ___ f Width of trench_"Z* --________________ Type of filter material___ _ i Depth of filter material____---------------- -Remodeling _ ___ __-_-___-Remodeling and/or repairing describe)------ - --- --------------------- - - ----------- -------------------------- - ------- ------------------------- --------------------------------- - ------ -•- - ----------'F'� -- ------ - _ ------- - : ------------ -------•------------------------------ ------------------------------- k hereb certif t I have prepared thi ap lication arid at the work will clone in accordance with San Joaquin County I ordinances, State W.S. and rules d',regula,+ions f +he an 6a quin oc I Hea District. (Signed)----------� _4----- -- --Q ------- li =� --- - --- ----- � rlf---_-(Owner and r o tractor) Title � � sr• J --------- ----------------------- ( 1 --------- -- (Plot plans, showing si o lot, location of system in rls, buildings, etc., must be filed w +his application). k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ---V ------------------;-- DATE--------/--ail--- / ------------ ` REVIEWEDBY--------------------------------------- ----------------------------------------------------------------------------------- -- DATE------------------------- BUILDINGPERMIT. ISSUED----------------- --------------------------------------------- -------------------------------------- DATE----------------------------------------- Alterations and/or recommendations:-1------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------- ----------------------------------------------------------------------------- - - ----------------- ----------------------- t --------------------- -------------------------------------------------------------------- --/---------------------------------------r----------------------------- - -----------------------I------------------------------------------ P1=RM1T No. - - ISSUED BY: _3______ Date FINAL INSPECTION Date--------------- �----� - � s � - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9.50 W 1639