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h APPLICATION FOR SANITATION PERMIT ,n (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544. E JOB ADDRESS AND LOCATION -- - ---------------------------------------------------------------------------------------------------------------------------------------------- Owner's Name--------------: . -- - ----- P.__r-------------------------------------------- Phone------------------------------------ Address `ate � ---------- ------ -- - - • ----------------------------------------------------- Contractor's Name---- ^-, - Jt --------------------- Phone-- 2±-7- Installation will serve: Residence Apartment Huse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ] Number of bedrooms - Number of baths Lot size______ 0___ / _________________________ Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑. Gravel ❑. Sandy`Loam ❑ Clay Loam ❑ Clay ❑ Adobe;K Hardpan E❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we11-----------------Distance from foundation--------------------Material_____________---_-___---_--_--___--_____________- ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material---------------------- ---___________. I ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building______-___________________-_______-___. t Distance to nearest lot line ------------------------------------------------ r A L Seepage Pit: Distance to nearest well________4-______Distance from foundation------3S0------Distance to nearest lot line____111____ Number of pits______I------------Lining material_-T__ -Kell(t-Size: Diameter_____ __�________-Depth__, -�?_____ ___________ t Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of lines-----------------------------------Length of each line---------------------------.-.Width of trench----------------------------------- Type of filter material_________________________Depth of filter material----------------------- 1 _ r- Remodeling and/or repairing (describe):-------------- --- --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ f ----------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- ----------- --------------------------------- hereby 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-.--•---------- ---- ------- ------- �--------------------- - ---- -- ----------------------------( andfor Contractor) -------------- - ------------------------------------- g-- (Title) -------------- (Plot plans, showing size of t, location system in relation to wells, buildings, etc., must be filed with this application]. FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY-----------------------------------------JK5: DATE 41 REVIEWEDBY------------------------------------------------------------------------------------- ---------------------------------------- DATE---------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------- ----- ---- -- - Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------•----------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 ----------------- ------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 44 '� yq- ___ ISSUED------ _S_1--.____(Date) FINAL INSPECTION BY:____ w V I PERMIT No---------------------- --------------- ----- --- iDate--------------�= ----- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i I 130 South American Street # Stockton, California E5-4-2M 4-50 W=1639