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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 Ordinanc o. 5 JOB ADDRESS AND LOCATION_ 4!' __ "____ _________"-"" �f � �- Owner's Name_--- E_s ------------------------------------------ Address-.-----f It „2a el4_ ----------------- ---------- Phone Contractor's Name_ �'� - _may" Phone- '- -------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ OtherX� .�4,D� Number of living units: ,❑ Number of bedrooms ❑ Number of baths [t Lot �I_A"--��o_a 1_ Water Supply: Public system 9 Community system ❑ Private F-1r 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.) Septic Tank: Distance from nearest _"__ '�f --------Distance from foundation_-_-" _-""__ Material in: --------- No. of compartments--------/-- ---------- CapacitY---^Tf- -- Size----R�X_"---------------Liquid depth---,`aFP-------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter--------------------------------------Depth------------------------------- Privy: 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----------------- F-1 Number of pits-__-'-----------------Lining material-__----_-___-__ ------.Size: Diameter----------------------Depth--------------------------------- ..D pl Field: Distance from nearest well--- ,_Distance from foundation--_ __1f_---------Distance to nearest lot line__s.� "_'___ . Number of`lines-------- ------- -- Length of each line------ _ Width of trench-----s;�,I - Type of filter materia ! L� -_---Depth of filter material-__-- 3- a Remodeling and/or repairing (describe}:_-- I-" ------------ --------------------- ----------------------------- ------------------------------------------------------------ ---------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance wifh San Joaquin County \` ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- ----i -- --------------------------------- - --- te - /or Contractor- BY:.-- -------------------------------------------(Title)- ------------ ------------------------- r (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-------------- - ------------ ------'------- ------------ --------------------- y�-`--- -�----- ---------- ----- -------------------------------------- DATE -BUILDING PERMIT ISSUED ----------------- ----- ----------------- ---------- ----------- ------------ -- DATE---------------------------- Alterations and/or recommendations ___________ -----------------------------------------------------------------------•------------------------------------------------------i- ----------------------------------------------------------------- -------------------------------------- PERMIT No•."I--- ISSUEp__"___-' -_------(Date) FINAL,,,INSPECTION BY---------------- --- Date------------------ ;;� ! SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California