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A` S� 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 A D LOC TIO/N-j_ C/ __3_______l�'l� Owner's Name _A_ { "------- ---- -- -- - '--' Phone_ 7 Address--J-,4 �'--------------- ��(( �} --•------------------------------------------------------------------------------- � sL ¢ a` '0 Contractor's Name----�+-t` Phone ^ Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths 0 Lot size______- ------------------------ Water _________Water Supply: Public system " Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Q TYPE OF INSTALLATION AND SPECIFICATIONS: (A) (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W Septic Tank: Distance from nearest well__---------Distance from foundation------U-___.Material--------- __ No. of compartments----------- ,------- -Capacity.__._ Q-¢.-------Size/__v �_'I �__'A.-F.Liquid depth.-5--t-------------- Cesspool: epth._ -t-- ----_--- Cesspool: Distance from nearest well----------------_Distance from foundation--------------------Lining material_-_-__--___-___------__--------_---__ ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- Privy- Distance from nearest- well-------------------------------------_-----------Distance from nearest building------------------------------------------ F1 Distance to'nearest lot line________________________________________________ Seepage Pit: Distance to nearest well---"'___-_------Distance from fou dation__-_��_______.Distance to nearest lot line___------------ A _ ____ Number of pits---------/-----------Lining material--- F+_Y_9ef_Size: Diameter----�� ____-.Depth---..-S- •------------- -- I Field: Distance from nearest well___-'_^---------Distance from foundation------/..2-.._ - -Distance to nearest lot line----��___-. Disposal Number of lines-------------�_ ____._-____jj___Length of each line------_. { "!._��_____Width of trench____��"------------------- Type of filter material)_�----fl/r -Depth of filter material-------1I--___--__. Remodeling and/or repairing (describe):--------------------------------------------------------------•-------------------.............--------------------------------------------------------- ---------------------------------------_1--------------------------•--------------------------------------------------------------------------------------------------------------------------------------------•--------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I ----------------------- 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)-----J.->,,-AA.....Pou_ _ G'^-" --•-------------------------------------------------------------------------------------.JQM";"Wor Contractor) • 1 (Title)-- �_�_�_ -10- " t. A - (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------ --- - -- --------- DATE-------_lam ------- REVIEWED BY--------------------------------- L -- r�. DATE.-------1 - !� BUILDINGPERMIT ISSUED----------- ----------•------------- ----------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----------------------------------------------------------------------------.......------•-------------------------------------- ----•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------•-----------------•------------------------------------------------------------------------------------------------------------------ -----•------------------------------------ PERMIT No------/_S:"1------ ISSUED__ `_ --- -- v_..[Da+e} FINAL INSPECTION BY---------- --- ----- - ------ --- -----�--------------------- Date-------------- ---- --- -- ---- - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W--t639