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APPLICATION FOR SANITATION PERMIT . 4; 0 (Complete in Duplicate) Application is hereby made to the San Joaquin Local Heaifh District for a permit to construct and install This application is made in compliance with County Ordinance No. 549. s all the work herein described. ' GIFG S. SL_. � a�P� I g3- loo 2S� l J B ADDRESS AND LOCATION __-- _ - } Owner's Name_._____-�_ --------------------------=------------------------------------------ Address---------------------- - Phone --� ---------------- --------------------Contracfor's Name---------•------•-•------ --------------------------- • t,; _____________________________ _ . Phone-- Installation ---------------------- will serve:. Residence �' Apartment House ❑ Commercial - Number of livin units: ❑ Trailer Court ❑ Mote! ❑ Other ❑ g Z Number of bedrooms - Number of baths� Lot size------ ate Wafer �,�: - Water Supply: Public system ❑ Community system Ej Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑PrSand am ClayLoam I TYPE OF INSTALLATION AND SPECIFICATIONS: 00 Clay ❑ Adobe❑ Hardpan ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------❑ ------ -Ca aci --------------------- Material No. of compartments----------------- Cesspoo : p ty-----------------------Size----------`------ --•-- -----Liquid depth--------- -----------. -. p well from nearest well-----------------Distance from foundati Elon______-___________.Lining material___________________ Size: Diameter___________________ --------------------------------------Depth--------------------------- ---------- Privy: Distance from nearest well =----- -----------------Distance from nearest b_ _ uildin ct . �1 ❑ Distance to nearest lot line_____ 9------------------------------------------- ------------------------------------- Seepage Pit: Distance to nearest well-----�_ Q�___Distance from foundation___- D_ I_ ___ Dis to nearest lot line______. _ Number of its________ p ...........Lining material. pp - i� � S Size: Diameter _ �p / _ D.isposal Field: Depth----- ,,.Dumbee,fro n nearest well_______________W-,DisFance from foundation______-______-_____Distance to nearest.lot line________ ❑ Number of lines_____-_______-_ - -- - - -----------------Length of each line----------------_----- Width of trench_--__--- ------ ype of filter material--------------------------Depth of filter material--____________-________ ---------- Remodeling and/orepairing (dye scribe): ______ { -- f --------------- #_ i ba 1------(.1------r�------- _ � 'j�' --------- { { ��All-_ _ LlJ- 1 --------------------- ------ --- ---------- - -- -- - -------------- ------ - hereby certify that I have prepared this application and - th San Local Health District. at the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the SJ (Signed)-.-_---------------- By:-------------- (Owner and/or------- --- Contractor) (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be efiled with this application). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______________ - REVIEWED BYDATE_-------•-____-- _ WLDlNG PERMIT ISSUED - ----- ----------------------------------------------- DATE------------«------------------ DATE ------ -- --------------------------- Alterations and/or recommendations:.______________________ ---------------------------------------------------------------------------------------------- ______________.____-___-_______-- 4 --------- •----------- - -------------------------- -- ---------_------------------ ____'___________.____"________________ -_«_ - --------------------- - - J PERMIT No. ______ ___ _________ ISSUED__-____ ___'_'J� .S� _(Date) FINAL INSPECTION BY:-------- ----------- Date tfr 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street E5-9--2M 9-50 W-1639 Stockton, California