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1 APPLICATION FOR SANITATION PERMIT ;• (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. 549. JOB ADDRESS AND OC ATION.....-190_k------ 8-x'v �� -------- 1--------------------------------------- -- Owner's Name--------- �'J'. ....-.. --- --------------------------------------------------- Phone----------------- ------------------ Address --•---- ----------------- ---------------------------------------------------------------------------------------------------------l-------e--- Contractor's Name- ------ ------- ------------------------------------------------- Phone__: I Installation will serve: Resi ence Apartmenf House ❑ Commercial E] Trailer Court El Motel E] OtLher/ Number of living units: Number of bedrooms Number of baths Lot size----------1/-0--kI --------------� Water Supply: - Public system Community system ❑ PrivateK Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobep< Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance from nearest well __ __ Distance fro foundation___� ___.Mate i I------ __ ❑ No. of compartments p ----->�!�-�i e----'"�1C_��__�_Liquid depth--------�----------. Cesspool: Distance from nearest well-----------------Dittance from foundation--------------------Lining material--------------------------------------- F1 . Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: 0 Distance from nearest well-_-----------------------------------------------Distance from nearest building_____________-_---_-____________ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line-_-_-____________ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- ; . Disposal Field: Distance from nearest wellDistance from foundation_-Distance to nearest lot line_______._ ❑ Number of lines-------____f---- ------------Length of each line-----1Q4_�'--------Width of trench--------_ t _`f---_-___-- Type of filter material__ k-----_Depth of filter material_______ - +�.. ' 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 andegulations of t e San Joaquin Local Health District. (Signed) -------- --- --- -- ------------------------------------------------------------------------(Owner and/or Contractor) By:------ --- ------------------ --------------------------------------------------------------------------------------------------(Title) = - (Plot plans, sho ing 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----------- ------------------------------- /Or -------------- DATE--------------; - ---- REVIEWED BY - ------------ DATE �1'--r-- ��-•---------- ------ .BUILDING PERMIT ISSUED-------------- ------- ------- -------- ---------- --------------------------------------- DATE Alterations and/or recommendations------------------------------------------------------- -------- --- ------------------ .•------- ------------•-•---------------------------------------------------------------------------------------------------------------------------------------------•- ------------------------------------------------------------------------------------------------------------ ----------- -------- - ----•-----------••----------- PERMIT No-------- - --------- ISSUED---.(.�-_-�.�--�-�--------------(Date) FINAL INSPECTION BY:---------- -- -- - --------------------------------- Date-------- --------------- SAN -------------SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street Stockton, California ES-9-2M 9-50 W-1634