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57a 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. JOB ADDRESS AND LOCATION---77-3---- ----- ' Owner's Name-------L?, 1// ' �� Phone Address------- � ------`l O------` 'S°' ��)) - /� y/ -Contractor's Name_,;(�f_.eA ____ # ^^ --________ PhoneT___=-!_`"_ 7----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: [!f Number of bedrooms !T Number of baths Lot size---.f�Q--- ..... Water Supply: Public system ❑ Community system ❑ Private Xl 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 well=___J'0-----Distance from foundation----/G..........Material__A�1_4�______ _ No. of compartments------�--------------Capacity----WA!--------Size___-X_1G-------------Liquid Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____._______.__________________..____ ❑ Size: Diameter-------------------------- Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distanco from nearest building--_____._________,_____.____________----_ 1-11 Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot {ine___--------______ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------------------------�--- .Disposal Field: Distance from nearest Vel____r0_______Distance from foundation____�4--"---__.Distance to nearest lot line=_=�______r0 --------Width of trench___,�__q--_'____.Number of lines____________ __ _______Length of each line_______ -------=----- .Type of filter material-- 0 ffK Depth of filter materiaL______t?_`'____ Remodelingand/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, State laws, and rules and regulations of the San Joaquin Local Health District. Sined ! ✓ • ---, �+.,} ------ - ------ ------------------------------------- ----------------------- for 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---------------------- f- ------ ----------------------------- -- DATE---------� t � -------------------- REVIEVED BY-------------------- -------------- ------------- -------- ---------------------- �. -- - ------------------------------- DATE------- ----------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations----------------------------------- ------ ------------------------------------------------------------------------------------------------- ---- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------- -- I ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ ------------ PERMIT No.--.3_-�_3---- ---- ISSUED------�/-�J- .---------(Datel FINAL INSPECTION BY:-----------/,/, -------------- Date--------------------------� -- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639 L