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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 3 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. 549. v '4p,5 _9- D,4-w E�[ �F— • `. �/`J = 1,,S` --fly S —07 JOB ADDRESS AND LOCATION_gDD---_ _r,0tk__ Owner's Name----- l ++.�.,. N - ----------------------------------- Phone Address------- Contractor's Name--------------- : i- Phone ------------------ Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: EP Number of bedrooms Number of baths �`�� �– LI Lot size------------ -------�----�--1--�'----- --------`------ Water Supply: Public system X Community system ❑ Private ❑ w Character of soil to a depth of 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.) _ 5 , ! Septic Tank: Distance from nearest well___14_0_----Distance from foundation______ __ Material____ J` , - ', Aj FIA S No. of compartments---------- --Size----_ _ix-'1__K�Liquid depth------4 Cesspool: Distance from nearest well_________ _____ Distance from foundation--------------------Lining material__________-----_ . 3 ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- ,"4 I� Privy: Distance from nearest well--------- -----------------------------------.----Distance from nearest buildingi _ v ❑ Distance to nearest lot line----•------------------------------------------- y Seepage Pit: Distance to nearest well----------------------Distance from foundation---_______________-.Distance to nearest lotdine______ ❑ Number of pits----------------------Lining material-----------------------Size:Diameter------------------------Dept h------- --------------- -- Disposal Field: Distance from nearest wefl____r"G----Distance from foundation---_1_ -----------Distance to nearest lot line------ ; Number of lines---------- - Ei ----- ----------_ Length of each line------ ---�----- -----Width of trench -- )'"-�---------- -----=-----1 . Type of filter material----f=j�-tr _------Depth of filter. material__-___- Remodeling and/or repairing (describe):________ ______ ____ ---•------------------------------------------------------------------•--------------- ---------------------------------------------------- ' ------------------------------------------------------------------_------------------------------------------------------------------------------------------------------------------------------------------------------- (n ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. n (Signed)--------- t ' r: (Owner and/or Contractor) By:--------------------------------------------- - ---------------------------------------------- ---- ------------------ ------------- ---------------- --- ------------- ------Title (Plot plans, showing 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------------------- _ ___ _ DATE______?--- _ ----- ---- - r REVIEWED BY ------------------- ----------------�-- ------- --------------- ------------------------------------------ ------------ ------------------------------- DATE------------ --- --- •- ---------- • --- ---------------- ! PERMIT ISSUED---------------------------------------------------------------- ---------------------- DATE- ------------------------------------------------- ------------------------------------ Alterations and/or recommendations:------------------------------ --------------------------------------------------------------------------------------------------- .___________ ------------------------------------------------------------- ----------------------- -------------------- --------------------------------------------------------------------------------- PERMIT No. ISSUED_________- __ --,r� - --�5----_-__-- ate FINAL INSPECTION BY:____r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639