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APPLICATION FOR SANITATION PERMIT 73 (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to con This application is made in compliance with County Ordinance N i construct and No, 549. install the work herein described. JOB ADDRESS AND LOCATION_,___ Owners Name__. r R I ------- W" ""U Q Address-------------- -- - -�-¢_"� - ----------------------- ----------------- �}, M -------------"---------------------------- -4j/�S"` -- ------•------------------------------------ ------ -------- - Phone Contractor's Name-____"._._,_•__._ - `--- --"" lnstalla}ian will serve: Residence " "• -"---" ------------ --------------------------------- - - ---- ------- -------------- -- -------- Apartment House Phone" Q Number of living units; ❑ Commercial t g Number of bedrooms ❑ Trailer Court ❑ Moto � Water Supply: Number of baths ❑ Other 4 Public system (�( Community sysfiem � Lot size"-"�L_Q-_-� ��(} Character of soil to a depth of 3 feet: Sand ❑ Private ❑ `" --------------- ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes TYPE OF INSTALLATION AND SPECIFICATIONS; pq Hardpan ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance°from nearest well ❑ Distance from foundation-_" ! No, of comp`artments____"___"_"______ ---------"-"____-Material __ Cesspool: Capacity Size ----------------------------------- `� Distance from nearest well--- .Distance from foundation- "_ Lining material depth_ Size: Diameter"__.�___ h ---------Depth---------- 1�L Priv -------------- ej y Distance from nearest well ❑ Distance to nearest lot line------------------------------------------------"---- ------ " Distance from nearest building 'See a g----- -------�---- -- ------------------- If p,ge it: Distance to nearest we))---------- ' Number of pits____"_____"./_________Lining"mDt�raal from foundation "- -- "___Dist nce to nearest lot line_ " # Disposal Field: Distance from nearest well______ � -.Size: Diameter_-" . �� -- ---------.Depth- `----- Distance from foundation____"-" "-___ Distance to nearest lot line_. El, Number of lines--------------- Length of each line---------_------- Type of filter material_ "-__----"-------Depth of filter material___ _ _ Width of trench"_""-""____- " -" -- - ---------- Remodeling and/or repairing (d�cri )k: e A� ---------- �L� RAO--- -- -- _ a ----------- -------- -- ---------------------y -------------------------- ----- - ---------------------------------------------•-------------------------------------------------------• " i her certify that have pared this application and that the work will be done in accordance with ordinances, S+ � d ul d' regulations of the San Joaquin Local Health District, th San Joaquin County (Signed)"__ _ ----------------------------------------------- # {Owner and/or Contract4 {Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must - - ---------------- ---- ------------------------------- --------(Title)---•---------- --------------------- ---- r be filed with this application). i FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY It REVIEWED BY--- ---------- PE ---- -- ----------------------------- ------- ----------------------- ----------------- DATE ` BUILDING PERMIT ISSUED = , �.� --------------------------------- DATE }era+ions and/or recommendations:_---"-"-,:_____ - DATE -------------------------------------- ------------------------------------------------------------ -------------------------------------------------------------- --------------- ---- - - t -------------------------------------- -------------- -------------------------------------------------••----------------------------------------L------_------------------ ---------- --------------------- --- ---- ------- PERMIT No ----- ISSUED----- ---� ------------ ---------(Date) FINAL INSPECTION BY: _-- ---------------------- ate------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ?1vf 9-50 W-1639 Stockton, California