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s� 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. � wq-rr-rX#..0 O JOB ADDRESS AND LOCATION J-------S-----------�------ "--f---------------------=---------'f----- Owner's Name--------------------- Al t - ------------ -- ------------ Phone- — ---------- Address ----•--- Address------------------ e 3 s G� ----------------------------------------------- --- ---------------------------------------------------------------------•---------------------------------- Contractor's Name---------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence 12( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms [;P- Number of baths ❑ Lot size______________________________________________________________ Water Supply: Public system ❑ Community system ❑ Private IJ ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam 9�'Clay ❑ Adobe ❑ Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sywer is available within 200 feet.) Septic Tank: Distance from nearest well.__-_.- �...Distance from foundation___________________.Material___-_�_�____- iJ!E r---------- [✓� No. of compartments-------�-------------Capacity---��_a__ ___Size_3 k__ __ _______Liquid depth_______-_____________ Cesspool: Distance from nearest well----------------_Distance from foundation--------------------Lining material-------------------------------------- F1Size: 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_.._-_____._____ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth--_------------------------0---- i Disposal Field: Distance from nearest well__f _______.Distance from foundation____/0_/_____Distance to nearest lot line_-______•________ X10-1- • N Number of lines- -- r _____ Length of each line_____________p____ Width of trench____ -fir ______-______--_-.__ �/ Z------- Type of filter material_ _ r _____]tpth 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, St a 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--------- . - ------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------- ---------------- / I-------------------- -----------------------------------------------------------------2`---------------•----------- Alterations and/or recommendations•_____________ ��} • ------•-------�� ------ L. - - 1 =�---'---------------------t.e. -- -------------- ---------------------------------------------- ---------------------------------------------•-------------------=-------------------------------------------------------------------- ----- -- -- -----------------------------------,------I------------------ PERMIT No-._3 -d--------- ISSUED-----_� L---------------------------(Date) FINAL INSPECTION BY:-----------, '� ---_-_V---------------------------------- Date------------------------ --------------------------------Date-------------------------- j----------------------------------- SAN -------------- - - -----------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W w 1639