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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------------ / 1 f =P�„ Owners Name �. _ Phone----- -- _0 # t -------------------------- e: Address - -- ----------- --------- . �} ------ -''� �¢-`�� ' ------.- -------------- ------------------------- --------------- Contractor's Name Name-------------------------------- d � o= 'G-f 7_470C_;/7----------------------------------- Phone--- "`'_ Installation will serve: Residence Rr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .? Number of bedrooms L? Number of baths [9 Lot size_"�-� _P_" __r,.` _��-- ----------------- 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: f (No septic tank or cesspool permitted if public sewer is available within 200 eet.)� Septic Tank: Distance from nearest wwy IIs N_ ="Distance from fou ation "_i_'`__,______M terial.-""___ _""_ _-" f ` No. of compartments-- .e-------------------Capacity-�'--ro.VC ----Size�r!a.f_= - � ----Liquid depth""r.:a?'-- `- ----- esspoo: Distance from nearest well-________________Distance from flation--------___________.Lining material____----_----------__----__-________ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- 'Privy: Distance from nearest well_------_-__ ----------- -___ _ ____---_ __---_- _Distance from nearest bu0cliin _ ------------------------------------------ El Distance to nearest lot line - ------------------------ Seepage Pit: Distance to nearest well-------- -----------Distance from foundation-------------------Distance to nearest lot line----------------- ❑ Number of'pifs-----------------------Lim- material--.--------------------Size: Diayet r-----' ----------------Depth--------------------------------- �F�Wiclth y-- Disposal Field: Distance from near 4t welle _�---___-_-Disfance"from foundation" -Distance to nearest lot line__!____""___""Number of lines Len th of each line of trench-- -- "" rt -------f--r- 9 Type of filter material__-";___-/ ,J 1: �� Depth of filter material____-- __--____--- Remodeling and/or repairing (describe)--------- ------------------------------ --------- f f' n f---------------------------------------------------------------------- --------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances` State laws Eine an 9ula+ions of the San Joaquin Local Health District, w ?}► f �- (Signed) f t. ''� +'' � ------ � _�"---�-' tr ct r�., 8�------ `moi » J -Contractor) or) -(Title) --------------- - (Plot plans, show! size of lot, location of systerfi in relation to wells, buildings, etc., must be filed with this application). y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE----,?''' -- /------------------------- f PERMIT ISSUED -------------------------------------------- DATE--------------------- ------ ------------------------------------------ - -------------------------------------- DATE ------------------------------- Alterations and/or recommendations--------------------------" ----•---------------------------------------------------------- ------------------------ PERMIT No.- -__ - -""-_-- ISSUED -- --- `--- I--------(Date) FINAL INSPECTION BY---------------- -�- -- ------------------------------ Date------ _0----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9--2M 9-50 W=1639