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APPLICATION FOR SANITATION PERM'1T I —IComplete-in_-D.0 Application is herebymade to the San oa u3`n`Lozal-F`ie�Di�Fi&fb7 mit,Fb co strut+and install the work herein described. ! This application is mqde in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION .rte' 41 6 15 r31��/�' �� <:R_41...`'�----��--------------------------------------- .S .� Lr------------ ------------------------------------------------ Phone--------------------------------- Owner's Name----------------- -�------------ - -------••-----�---� - - Address ° 1Ov_rlq __f-A � ------- r' ._ ------F-- --- -------------------------------- - Contractor's Name ----------------------------------- Phone Installation will serve: Residences+&Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: a Number of bedrooms ❑ Number of baths [;;)~.Lot size_______________________________________________________--____ Water Supply: Public system ❑ Community system ❑ Private Lid' V1T Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ C1 ay Loam ❑ Clay ❑ Adobe{Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------___-- __Distance from f ndation____________________Material______- [ No, of compartments--------�------------CapacifY-------- i __.a-S_ __7---------Liquid depth--- ---------------- 1 Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material__________________________--___-_____. ❑ Size: Diameter--•------------•----------------------Depth----------------------------------------------- s Privy: Distance from nearest well-------------------------------------------------Distance from nearest. bAdin g----------------------------- -------- Distance to nearest lot line------------------------------------------------- LSeage Pit: Distance to nearest well----------------------Distance from foundation, , _.- =-Dist.anee=toearest�fo�`line_r"' �- ❑ .,Number-ofrpits_--- " �Lining�ma a it a_______________________Size: Diameter________-..____________-Depth---____-"�:",�.__r-----p_--- " a Disposal Field: 'Distance from nearest well____ ____Distance from foundation___ _+_______Distance to nearest lot line----------------- 1711 __ _-____ i ❑i Number of lines------------- ---- ----:--Length of each line-------_- - -r#-------"Width of trench-__.,-�"----------------------- Type of filter material �_!_5-_C_ ,-%Depth of filter material-----AF______-.____ - -------------- - -------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing {describe}______________ _ ____________ _ ------------------------------------ ! ----------------------------°�----------- - '--------------------------------- ----------------------- ------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I 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. 9w f nes Contractor) (Signed)---•-------=------------------------------- -ter �y- - {Ow and/or tor) -- --- / �. (Piot plans, s owing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application): FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = Gds' ------------- DATEor ----------------------- REVIEWEDBY-------------------------------------------------------------------------------------------------------------- DATE--------------- BUILDINGPERMIT ISSUED------------------------------------------------------------ --------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----- ---------------------------------------------------------------------------------------------------------------- -------------------------------------- --------- -=---------- •------------------------ -= 1A14 �Vi i'=---------� --------=- -------------------------'-- ------------------------------------------- t ---------------- --------------------------�---- .fi ---------- ---"-- ------,--- ------ ------------------------------- ---- ---------------------- PERMIT No.-__ 4:-�______-- ISSUED__, .-a --I'--- [Date] FINAL INSPECTION BY______________ --"-- Date---- ---------------- � -------------- G SAN JOAQUIN,LOCAL. HEALTH DISTRICT 130 South American Street x Stockton, California ES-9_2M 9-50 W=1639 y `