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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. --- -------------------------------- ------------ -I--------------------------- JOB ADDRESS ANS LOCAT11 ------ ------ -------- LI-0, Phone--17—" Owner's Name-._"--ev---!------- --- -- -------------------------------------------------- % , , 0 -------------------------------------- Address------I-•- --- ---------------------------------------I--------------- ---------------- ------------------------ Address......I...9 j_ ------ Phone---------------------------,-= �•• . S Contractors hone-------------------------- Contractor's Name_____- ------ ------I ---------------------------------------- iCmotel Other. CommerciaILTrailer EF Installation will serve: Residence Apartment House E q Lot size__.�5_0. x ;ya4o" ---------- Number of living units- Number of bedrooms [Z Number of baths L ---------------J----------------- Public system F1 Community system ❑F1 Private EE44�1� Water Supply: I Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand 0 Gravel F1 Sandy Loam Ely 0 Cl LoamE] TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public ewer is available I ifhin 200 feet.) a]-- -- --------------------- is Distance ai�on.,_143_0--- teri ........ --- ----- Di t f M f A , ----1, ---------- Ca -- n Septic Tank: Distance from nearest well Sizes ' ---------Liquid depth------------------------------ Sept' . ...S..,,�Vy- - ------------Liqui -- - ---- --- - No. of compartments----------- - ----------Capacity I _-__.Lining material._________-____________.____- - ------- Cesspool: Distance from nearest well________________"Distance from foundation-__.__.________ --------Dept h------------------------- ---------- ---------- Size: Diameter------------------------- --7, ❑ Privy: Distance from nearest well________.___--------------------------------------Distanc,94from nearest building_______---________--_ --------------------- Privy: ----------------- /° ❑ Distance uilding------------------------------------------ Distance to nearest lot line__________________.--------------------------flu.Zon--- Distance-to nearest lot line------------------ ge pit.— ___�Qista�icq.fo nearest well ---Distance,f rom Seepage - ——------------------ Depth------------- ---- -- 2 k, , . ----------------------Dept of pits----------------------Li in material---------------/-'---Size: Diameter X, e� frof;(foundaf�_;�& --Distance to nearest lot [jne__A V-------- Disposa ield: Distance from neares Distance 01 Width of trench--- /I------------------ each line--! th of Numbe� of lines- th of filter material---------:------------ Type of filter aterial 19-0-1 _.D Remodeling' and/or repairing (desc - --------------- --------------------------------------------------- ------------------------------------------------------ ---- ---- ---- ------- ---------------------------------------------------- ----------------------------------------------------------------------- ----------------------------------------------------------.;----------------------------------------- ------------------------------------------------ -----------------------------------I-------------- ----N------------------------------------------------------------------- ---------------------------------------- ----------------------------------------------------------------------------------------------- --------- thaT the work will be done in accordance with San Joaquin County V that I have prepared this application and I hereby certify p of the San Joaqi1in Local Health District. ordinances, State laws, no-quies regulations, -------------------------------------------(Owner and/or Contractor) J- --- ----------- --- -- ---------------- (Signed)- -------------------------------(Title)--------------------------------------------------------------- ------- -------- -------------•------------------------------ --------w-e -s, guildings, etc., must be filed with this application). (plot plans, showing siz ot, location of system in rela on to, F DEPARTMENTiUSE ONLY -_ _-I--------- ----W-------------------------------I----------------------------- DATE-- -- _- APPLICATION ACCEPTED BY--- DATE tI REVIEWED BY----------------- ------------ - -- BUILDING --- -------I-- ----------------------------_----------- - PERMIT ISSUED -- -------------------------------------------------------------------------- --------------------------- DATE--------------------------------------------- Alterations and/or recommendations------------------------------------------------------------I --- ---------- ---------------------- ------I---------1-------------------------------------------------------- -----------------------------------------I----------------------------I----------------------------------- I ----------------------------------------------------------_---------------------------- I------------------------I----:_--------I-------------------------------------------------------------------------_ --- --------------------- --------------------------------------------- -----------------------------I----------------------------------------------- ---------------------------------- ------- ------------------------ ----------------------- --------------------------------------------------------- ------------------------------------------------------------------------------------------------ -- - ------L-------------- ---------- - - - PERMIT No-___10--------- ISSUED_-" ----- ---------------------- -- - ---- ------------------(Date) FINAL INSPECTION BY-_ - 1/j/-------- Date----------------- --------------------------- ------ SAN JOAQUIN LOCAL HEALTHPSTRICT 130..South American Street Stockton, California ES-9-2M 9-50 W-1619