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PP ICATION FOR SANITATION PERMIT t Vp�ic�af�iion (Co late in Duplicate)� is hereby made to the S�n Joaquin Local Health District for a permit to construct and install the work he described. Th is application is made in compliance with County Ordinance No. 549. �ld'h �(� C.+ v E a 7.1.4 S 7- " JOB ADDRESS AND LOCATION --------.- - k r 7- -_r ; Phon - � Owner's Name------- _ ---------------------------------------------------------- I ------------------------------------ = f3 —Address__ ------------ Contractor's Name--------------------- � --------------------------- one---- ----------------------- ----- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: JE Number of bedrooms E�j Number of baths ❑ Lot size_________ �a__, �4` - -------------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobev Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ~_ f Distance from foundation_f_.�_______.-___.Material___________________________ Septic Tank: Distance from nearest well_,4_ ----- -------- _ _____ No. of compartments--_.---�.--------------Capacity--J Y-D a------Size__ V-KA---- ---•-Liquid depth---------- ----______ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___----_-______________._---___; ❑ Size: Diameter--------------------------------------Depth------------------------.Z------------------------ C Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------- 171 _____-- -_________________❑ Distance to nearest lot line------------------------------------------------- Seepage ------------------------------------ ----------Seepage Pit: Distance to nearest well----------------------Distance from-foundation------------ ___.._.Distance to nearest lot line___________„ ❑ Number of pits----------------------Lining material_----------_----------Size: Diameter------------------------Depth-----------------------------1r"� Disposal Field: Distance from nearest well-__344 istance from found.ation______j __ F7istance to nearest lot line__,_____________T-� r �__ - -----Width of trench------- ° - ------ k Number of lines________________________ ._Length of each line_______ �_I - + - Type of filter material----->�_____�__�'�__Deplth of filter material_____,�_�'_-s-_e_r-_ i yi - --- �Y`oZ1-�"" xx �- ------�------�`�YL.?�� _'�j-----__--- Remodeling and/or repairing [describe)_________________T_______--.-_____--------- ------•--------- W- -A='-R- - ---`ter' r ---------------------------------------------------------------------------------- F __________________ _______________________•_______________-________________---_-__________---_______-__---_____-__________---____________________---_________-_-__...____..______-_________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 9p ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Y� �'{ }' '` ,.s..#a�t•" .� : . ------------------------------------ (Signed) (Owner and/or Contractor] _ . ------------------------------------------------ --- --------(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 �,,•,,•x --� - - DATE----- --- ------------------ DATE REVIEWED BY----------------------------------- ------------------------------------------------------------------------------------------ BUILDING PERMIT ISSUED--------- DATE------------------------------------------------------------- it •------- -------------- �-------------.-,--- ----- Alterations and/or r_e�caoa.m� m�(�1e"ndati ns Y- , � mss . ----------- --- ------------------------------------------- - ---------- --------- ------`'---------------------- ---- PERMIT N ---- --- ------- ISSUED------ - --� `� `�?----- -(Date) FINAL INSPECTION BY:--------- ------------- ------------------------- Date-------------------r----- ------ 0------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639 r. R f-