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APPLICATION FOR SANITATION PERMIT yo d [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. - - a �E 3 JOB ADDRESS ANDmAT10N____- -- _� ----- Owner's Nae-...------ ----------------�____-- �L.rrS ------- -------------------------------------------- Phone------------------------------------ Address------------------61 --- ---- - -- --- ------------- Contractor's Name---------------- /—Y .------- ---- -- ---------- ------------------------------------------------------- Phone------------------------ ---------- Installation will serve: Residence A Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: $ Number of bedrooms umber of baths ] Lot size_. Water Supply: Public system ❑ Community system ❑ Private (/!� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay'0- Adobe❑ Hardpan , TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic fan or cesspool permitted if public sewer is available within 200 feet.) Septi Tank. nce from nearest well_________________Distance from foundation--------------------Material________--_-____------___-----__---------___-_-_ N . of compartments--------------------------Capacity-----------------------Size-------------------------------Liquid depth-------------------------- Cessp 1: Distance from nearest well_________________Distance from foundation--------------------Lining material--------------------------------------- F ---_---_____--------_-----.-_-_-__.❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- . Privy: Distance from nearest we'll-------------------------------------------------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: Diam tern Depth-----------------------------�- Distance from foundation_ _ _ Distance to nearest lot line Disposal f=ield: Distance from nearest `�ell____��j__. __ _ __-____ ter ____.._ Number of lines------------{-------- -------- Length of each line--------�� - / --Width of french---� _---_--------_------ Type of filter material___�� Depth of filter material_______�15_ ______ Remo Ing and or repairing escri e]:__-_ _ �_ �-- tis ---- 4 "a't..-__ ---------------------------------------------------------------------------------------------------------------------------------- -----------•----------------------------------------------------------- ------- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed)- ,.� ----------------------------------------------------------------------------------------(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--_---------------------_-----__ REVIEWED BY------------------------------------------------------- - DATE a. © '� ---- BUILDING PERMIT ISSUED--------------------------- - DATE------- ----------------------- ---------- ------ --------- - Alterations and/or recommendations------------------- / ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- --------------------------- ---------------------------------------------------------------- ------------------------------------------------------------------------------------------- -------------- -- - -- �((JJ 10��3 PERMIT No�_CJ___�-�-- ISSUED----- ----------------- ------------- ------(Date) .FINAL INSPECTION BY:__________-- _-- ---k- -- -------- Date- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639