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APPLICATION FOR SANITATION PERMIT , `k (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__________ g9 Owner's Name--- - --- - -- -- - '_ L/ - = Phone q - - - ---- --------------- ------ Address s- --- --------- ---------- -f ---' + Y Contractor's Name ----- - ---------•------------------------------- ----- Phone ------------------------------------- ---------------- .Installation will serve: Residence Apartment House p Commercial ❑ Trailer Court ❑ Motel El Other ❑ Number of living units: Number of bedrooms `�(- �- Number of baths Lot size____________X___ ___------___ Water Supply: Public,system [] Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)0 Septic Tank: Distance from nearest well_ _ __-__-Distance from foundation_____-----------Material___, -s.0 4410 a C No. of compartments--------5---------------Capacity--- vat+ sSizeo _74- 7��f'-__-Liquid depth____.-��-y. 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 material-----------------------Size: Diameter-----------------------Depth----------------------------i---- xDisposal Field: Distance from nearest welL__� _____.Distance from foundation___:'f ___ Distance to nearest lot ling----._r_______ �l r-. [� Number of lines____a-'L' L _ line___aT -_�D _---.Width of•trench___ 771-/- ----------------- Type of filter material _ (____.Depth of filter material______________________ -Remodeling and/or repairing (describe):----------_ ___ ------------------------------------------------------------------- ----•---------- •----------------------------------- --------------------------------------------------------------------------------------------•------------- ----------------------------------------------------- ---------------------------------------------------- --------------------------------------------- `--------------------------------- ---------------------------- 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, �anrules id' rejulations of the San Joaquin Local Health District. (Signed)_, - --------------------------------------------------------------------------------{Owner and/or Contractor) By:-------------------------------------------------- - y --------- ---------- I (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-------- •- DfATE .� REVIEWED BY--------------- --------- - -------------------------- ---------------- DATE BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------------------------. DATE--------------- Alterations and/or recommendations_________________________________________..____ ---------------------••-----------•---------------------------------------------- _ •-------------------•--------------------- •---------------------- -----••-- 1 ------------------- ------------------------------------------------------------------•-------------------------------------------- ". ---------------------------------------------------------------------- PERMIT No.__�_1�---------- ISSUED-----_ _ -t- -- 5'- -----____--(Date} FINAL INSPECTION BY:_______---- -_v �� Date--------------------s I '.) ---/--------------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639