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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-------- Z53-1--Z-4--- S t Stvckton--------------------------------------- --- Owner's Name-------------------------------------------- _ ---------------------------- Phone----5-55-`T5-------------- Address----------------------------------------------------- 2-� E+ � h• S r e e t i-- Stockton Contractor's Name lixe ------ Phone-----9 -9 0- Installation will serve: Residence)X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f�05ure 0t Number of living units: [� Number of bedrooms m Number of baths JL] size__ size________ Q --------- Water Supply: Public system ❑ Community system ❑ PrivateXI Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe$X 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----�Q1-----Distance from foundation , -----Mf terial _____�__C ----_- ------__. No. of compartments----------2------------Capacity_8__Q...G---- Siz - xsquid depth----------52------------- e5 _ 63 Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material_-___________-_________________._____. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from .nearest well-------------------------------------------------Distance from nearest building___________-_______-_-------------------- r ❑ Distance to nearest lot line___________________________________________-___ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____-______.____ \ ❑ Number of pits----------------------Lining material----------------------Size: Diameter------------------------Depth--------------------------------- 3 Disposal Field: Distance from nearest well_____ Q�____.Distance from foundation____20�- ___Distance to nearest lot line_____ _________ fl Number-of lines-------2------------------------Length of each line-------_E� t= O---.Width of trench------�F-----2----------------- Type of filter material---._-lf' ---Rk-Depth of filter material---------___-_____ Remodeling and/or repairing (describe):--------------New__lnS_Callsati.oa--------------------------------------------------------..---------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------. ---------------------------------------------------------------------------------------------------------------------•---------------------------------------------------- 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. (Signed)---- • T4 S- -NC--------•------------*-----------------•---------------'---------------! � +�Contractor) - BY: F Ali -------- ------- Title Estimatoz', . . -- ---------------------------------------------------- (Plot plans sho in g size of lot, location of Sys m i relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------ -- - ------ ------------------------------------------- DATE---------- - -------------------- REVIEWED BY---------------------------- ---------------- ------------------------------------ ------------------------------------ DATE----------------------------------- ------------------•---- BUILDINGPERMIT ISSUED------------------------------------------------------------------- --------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations---------------------- - ------------------------------•-------------------------------...---------------------------------- - --------------------------------- --------------------------------------•-------•------------------•---------------------------------------------------------------------- -------------------------------•------------------------------•------------------------------------------------------------------- --------------- -----------------------•------ ---------------------------------------------------------------------------------- --------------------- ------------------------•---------------------------•---------------------------- -------------------------------------- ---------------------------------------- - __ Date FINAL INSPECTION BY_____ ___ _____C- --------------------------- PERMIT No.��----•------ ISSUED---- ------`- / { I Date------------- - ,� ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1539