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APPLICATION FOR SANITATION PERMIT 04g ` { (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 wit County Ordinance No. 549. ► JOB ADDRESS.AN OCATION_---___. ______ �_ 7 =- ----O _ Owners Name-------- �--L-V-_��---------�--�� ---- Address------------ --/---'P--- .��- -� ----------- Phone_-�(�---- -------- ------- - ---- _ ev�Y 1 ------- l t' ----------�e-4- Contractor's Name_-k -__�- ------- -j9-��'-lsy---- -- --.--lo/vSf----- ,.�/ ------- Installation #-6�-1�t-------------------- Phone__ Installation will serve: Residence A Apartment House ❑ Commercial Number of livingunits: [ ] ❑ Trailer Court ❑ Mosel Other ❑ Number of bedrooms 0- Number of baths [A Lot size--- Water Supply:y. Public system .Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy p Y ❑ Clay Loam ] Cla y ❑ Adobe Hardpan, '7 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_______________ ❑ No. of compartments Capacity - ----.Material------------------------------------ ---------------Size--------------------------------Liquid depth--------------------- Cess -------- Cesspool: ❑p Distance from nearest well-----------------Distance from foundation____________ Size. Diameter-------------------- ------Lining material--------_--------- • ----------------Depth i Privy: Distance from nearest well____________________ __ _--Distance from nearest buildin❑ Disfance to nearest lot line______________________ � g---------------------__----- _ _____--� Seepage Pit: Distance to nearest well-_- ---Distance from foundatton__VV0___-_____Distance to nearest lot line___ Number of pits__d_61 _______Lining materiali _ B l' ' , Size: Diameter____ __�--�__�_ � Disposal-Field: �Distance:from nearest-well=_-- -__ _;Distance=from foundation__ ------Depth_-- --_7_---______-_-- --------.Dis#ance`to nearest iol�hin�`- -°*- Number of lines___ __ Len th of each line;__- -_ _ Type of filter material_ g Width of trench---_ _'-__ ----------------------- -------- --�° -___- Depth of filter material-_----- ------------ "Remodeling --------- ----- ----- Remodeling and/or repairing (describe):__ __----_ --------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ------- -------------- -------------------- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin-------------- County ordinances, Stat a s, an rules an gulations of t San&J0ain Loc ealth District, fi' (Signed)---------- .. � (Owner d/or ontractor) By------------- = ri-- (Plot plans, showin size of lot, location of system in r lation to wells, buildings, etc., must beefil wi}h this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- _ = DATE OF REVIEWED BY------------------------------. _____ _____________________ BUILDING PERMIT ISSUED__-- - --- ------ ---- f---- --- ------ DATE-- ---- _--- DATE ------------ A aerations and/or recommendstions: ________________________ ---- ----�- ------ ---------------------------------------------------------------------------------------------------------------------------------------- -il� -- ------ --------------------------------------------- --- ------ - r - ------------------------------------ - ------------------------------------------------------------------------------------------------------------------------- ---------------------------- ----- ------------- - - -- - - - :_ _ ----------------- ------------------------------------------------ PERMIT N _ _-.--_----- ISSUED_L ----------------(Date) FINAL INSPECTION BY: --------- ___ --------------------------------- Date ---------------------------- . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639-�� Stockton, California