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�.�, -'•� - � � �'� � p r r a V` APPLICATION FOR SANITATION PERMIT 1 (Complete in Duplicate) •r�3 f a��f I o'�" , Application is hereby made to the San Joaquin Loc'al,Health District for a•permit to construct and install the work herein described. 1 This application is madelin compliance with County Ordinance No. 549. RIdle ;2 t JOB ADDRESS AND LOCATION:.._. le__'I 54)-----71_°, __ -1 T ----,� � --- 1-6 __f_1f - /__---------- 'Cy---------- Owner's Name-__� -�el-G-A ► �'di ,�f t Phone_ ------- Address --- {-. 8-or r �-'0vL c �---------------------------------- Contractor's Name----------------------3A*.',-xt-e---------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial [IV Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: ❑ Number of bedrooms El Number of baths E] Lot size------' _ -+__, ____. __ _'______________ t _ Wafer Supply: Public system ❑ Community system ❑ Private ] O 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam JA 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---3d0__----Distance from foundation____- 4___ • No. of compartments Capacity-. -_--_Size---- -___XVW_ Liquid depth___ ___________ P .S_ G V" y•. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ - ,. ❑ Size: Diameter------•--=---------------------------Depth---------------------------------------------------- , Privy: Distance from nearest well-------------------------------------------------Distance from nearestbuilding__________.____________________-_______- ❑ Distance to nearest lot line u---------------------------------------------- Seepage Pit: Distance to nearest well________________-_-=_Distance from foundation---_______________.Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth---------------------------___--- Disposal Field: Distance from nearest we1_SaQ______-Distance from foundation------L_'I--------Distance to nearest,Iqt line_____--------__-- , Number of lines_________ ___________Length of each line_----tomof trench_______ �------------- 14 y Type of filter material__sa_�._Rac k Depth of filter material__ Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------------------------------------ ---•------------•------------------------------------------------------------------------------------------------------------------------------------- ----- --- - ----------------------------------------------------- - ----------------------------------------------------=------------------------- ------------------------------------------------------------------------------------------ ---------------------•--------------------- i, I hereby ce ify that I have prepared this application and`that-tfie i+rork wil['be done.in acc" dance with,San Joaquin County `! ordinances, St a aws,..and rules and regulations"o the San Joaquin Local Health District. y ,.�. --------------------Owner and/or Contractor (Signed)--- ------------------------------------------------------- ----- -- --- $Y� r. U- ,r------------------------------------------(Title} > ------------------- -2 ----------------- ` Plot fans, showin of lot, location of system in relation to wells, buildings. etc., must be filed with this application). { ( P g Y g ) FOR DEPARTMENT USE ONLY '• APPLICATION ACCEPTED BY------- + i - ------ DATE-------/ ---------------- REVIEWEDBY---------------------------------------------- ' --=-----------------`' --------------------------------- DATE------ "-------------- ------ BUILDINGPERMIT ISSUED--------------------------ft------_.---------------------* --------,------------------------------- DATE------=------"'--------------'i!-------------------------- Alterations and/or recommendations-------------------------------------------- -!----------- ---------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- t ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- =------------------ PERMIT No------��-------- ISSUED-_----re J�/ -----{Date) FINAL INSPECTION BAY}:-- _-- -------------------------------- Date-------!v f ------- -------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639