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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 withCountyOrdinance No. 549. ,��' JOB ADDRESS AND LOCATI N- !l � A' `''a A�� - ----------•------ ----- - - .------------------------------------- Owner's Name IDl / ----------- +---- -------- -------------------------------•----- ------ Phone------------------------------------ AddressL-.-Q! Imo-- 4/-------- ------ -,------------------------------------------------------------------••---•- Contractor's Name---- SAA... �� ----" -----��------ - - -- -------------------------------------- Phone-f-F1Aa_7--------- Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths El size--- _Q_0_1---- _�_ _�__ �--------_------ Water Supply: Public system ❑ Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clayx 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 well_________________Distance from foundation--------------------Material______-_----_-----_______________-______________- ❑ No. of compartments--------------------------Capacity-----------------------Size-------------------------------Liquid depth--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ElSize: Diameter--------------------------------------Dept h---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_____________-__--___-___________-______. ❑ Distance to nearest lot line--------_-----------------------_--------------- rr de r Seep e Pit: Distance to nearest well______________________Distance from foundation-__.P_ _____.Distance to nearest lot line_ Number of pits--------/___________Lining matenalXItx _-_SiXe: Diameter----3—?_ _ -----Depth---S(s--------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_____-_-_________ _. ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french---------------------------._------ Type of filter material-------------------------Depth of filter material____________-___--_____ Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------- --------------------------------------------------------- --------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 12&Aand rules and regulations of the San Joaquin Local Health District. Si ned ----------------------------------- /or Contractor) P Y: -------------------------------------------------------------- - (Piot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). ,r FOR DEPARTMENT USE ONLY 00 00 APPLICATION ACCEPTED BY. _--f__ ,------- -- - �- ii"-.4`" � - ---------------------- DATE. f REVIEWED BY------- 00/ ------------ -------------- ------------------------------------------ DATE-------------------•- BUILDING PERMIT ISSUED-----------------------------------------------------------•------------------------------------------ DATE Alterations and/or recommendations-------------------------•------------------------------------------------------------------------ ----------- ------------------•---------------•-----------------------------------------------•----------------------------- --------------------------. ---------•---------_.- PERMIT No......)-(- --------- ISSUED- _-f---1-- - -----------------(Date) FINAL INSPECTION BY:--- ---------------------- Date---------/---'?-rr-`-�f-----•------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton; California ES--9-2M 9-50 W-1639