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f � . 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. �I : 1!x`7_ ra-70r p JOB ADDRESS AND LOCATION_____________ __AL( t 4=c3P-A_t_ -- ►� &�1 Nct Q ------------- - -----------------------------------�--.F-fn..---------2 ��------------------------------ Owner's --- �j c3' Owner's Name--------------'�_-�-�2c.-C-r9_.-n 1------e-� ----------------------------------------------------- Phone--------------------=--------------- 1�'j Address------------------------------------ �a_U tJ� ,, m , ------------------------------------------- w.- ------------------------ Contractor's 'Name----------------- ''�` Phone------ ------ -------------- 00" Installation will serve: Residence Apartment House Commercial Trail " ❑ p ❑ ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size f Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS:(No septic flank or cesspool permitted if public sewer is available within 200 feet.)Septic ank: Distance from nearest well__-___----_-Distance fro foundation-__-------.-_.Material-__--_No. of com artments-------------�-___--Ca acip --- p tY----- DC7-----Size----.3.?�._��-�'-----Liquid depth----•-Cesspool: Distance from nearest well_________________Distance from foundation---_,_------.----___Lining material------------------------------------- ElSize: 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 maferial-----------------------Size: Diameter------------------------Depth-------------------_- Dis os Field: Distance from nearest well------ —__--.Distance from foundation----------------Distance to nearest lot line----" Number of lines_____ __ `______Length of each line----- b.- _ �-�-.Width of french---------;�O_-'� Type of filter material-------------------_-___Depth of filter material___:6? Remodeling and/or repairing (describe:__-__-_-_-----._--l- c -------------- ------------ r ----- ----- ----- - ------------- -------------------------------------------------------------------------------------- -------------- � w r- -------------------------------------------------------------- ------------- --d ----------------------------------------------------------------------=---------------------------•--------------------------------- - 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. I (Signed)----- ---(- -- � �' ----------------------------------------------------------------(Owner and/or Contractor) BY: '�2 -_ , - "-"-------------------------------------------------------------------Title)--��-1^' r ------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY....------------------------------------^------------- ------- -------------------- ------ DATE----- REVIEWED BYDATE -------------- ---------------------------------------------------------------------- DATE--------Z `- ------------- } G PERMIT ISSUED------------------------------------------------------------------------------=----------------------- DATE ---------------------------------- a Alterations and/or recommendations----------------------------------------------------------------------------------- -- -------------•---------------------------------------------------------------------•--------------------------- - ------- --------------------------•-----------•------••-------- ------------------------------ ------------------- -----------------------------------------------------------------------------------------------------------------•-•-----------------------••-------------------------------------------------------------------------------- PERMIT No.---- _13--------- ISSUED-------- - -- -------(Date} FINAL INSPECTION BY----------------------- --- - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9S0 W-1639