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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made o the San Joaquin Local Health District for a permit to construct and install the work herein described. T This application is made in �'mpliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__._ (T/ /"" �, , ,[� r� C Glr rtl fig -------•--------- ------------------------------------------- ------------Owner's Name_ ./F7'-t � -C+ r l f/ �.---• ------------ ----------------------- Phone----11----- --------------------- I ------------------------- AddressJ `'{ ^� y � i l?- , ' .rr;�/ p ----------------------------------------------------Contractor's Name--------==-===----=---_._'r=-----T �------- ------------------------------------------------ ------------•--------------- _ Phone---- -� � --------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: '❑ Number of bedrooms ❑ Number of baths ❑ Lot size_____________"":-____ Water Supply: Publics sterfi } PPY� y ❑ Community system ❑ Private ❑ Character of soil to a depth f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �i Septic Tank: Distance from nearest well = p' ,�� Distance from foundation___.__/ _--_---.Material___ ^_ y__ *__" _ -----Ca Capacity 00 ,Clv �' ---------- El No. of ca�mpartments-----------'�------- P fi/-------�-------------Size----- •- -----------�-- p ------Liquid depth------�-E------------- Cesspool: Distance from nearest well-____------------Distance from foundation-------------------.Lining material____- "_____________ ❑ Size: Dia meter---•----•--------- ------------------Depth_--------------------•------ - - 11 - - ---------------- Privy: Distance �Fom nearest well-________________________ Distance from nearest building________________ Distance to no lot line _ Seepage Pit: Distance t�. nearest well----------------------Distance from foundation-------------------- Distance to nearest lot line_________________ ❑ Number ollu pits------------------""--Lining material.--------•------""_"---Size: Diameter_--------"-"_-•_ �. ------.Depth------------..................------ = Disposal Field: Dist ance friom nearest well___=_�� foundation � �^�� nearest Distance from ---a6? .___Distance to nearest lot line__ __ �._ Pte,1 r i Number of lines__ _ _ lines ----- Type-of filter material---- s f��iy� .pngth of each ------ =----- -- -.Wi th of •trench ---------�� e -,.--epth of filter material_____ � a' 3 Remodelin and/or repairing describe :_____-_____ _= - ----�.�-- ---�b ---------------------- ------------ -- - -------------------------------------------------IIU.._-------------------------._ - - ---------- ...' �� --------------------------------------- ' ------------ Ihereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---•------ n, --' . ` r=• --- v<c s -----------------------(Owner and/or Contractor BY� ----------------------- - ----- ------•---------- -----:----------------- Tale _ (Piot plans, showing size of lot,lcation of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION `ACCEPTED BY11__________ _______ ��- �--� REVIEWED BY �p DATE ------------------------------ - ' ---------------------------------------------_ >' BUILDING PERMIT ISSUED-----1IG DATE_------ - - ------------------------------------------ --------- �---------. - DATE { "' ..Alterations and/or recom_menda ions: { -- IWAI -? ---------- t �r { - _ r C _ " / 6-s.-y.�a� :-------- -------------------------------- � --`e-'-`---- ---+-------------- = = - --- - - - - --- - - 0. PERMIT N,6Y-d�------ ISS UED----- S-_/------- (Date) FINAL INSPECTION BY:__-:_ -✓ # Date - SAN_ JOAQUIN LOCAL HEALTH DISTRICT L 130 South American Street ES-9-2M 9-50 w=ie39 Stockton,,California