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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 Cou ty Ordinance No. 549- JOB ADDRESS A LOCA TION -- - -- -- - --- -- ------------------------------------------------------------------ f Owner's Name---- - i ---------------------------------------- - ------ ------------ Phone_�_��"�C50------ Address------�_�-� ----'-- ---- - ----------- ---------- - - ---------------------------------------------------------------- -------------------------------------------- '�. Phone----------------------------------- Contractor's Name--------------------------------- ----------------------------- ------------ ------------------------------------------------------------------ .Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Ep Number of bedrooms [)] Number of baths [13 Lot size_____ S.0--x---I:"--------------------------- � Water Supply: Public system Ll Community system ❑ Private Y", 'w vw"_ r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ .� TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se?fic Tapk: Distance from nearest well_________________Distance from foundation---------------------Materia4------------------------------------------------ - -----Ca Capacity ------------Siz ---------------------1-----------Liquid depth--- -------------------- n` No. of compartments-------------- ----- p tY---------- e ! `V Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter--------------------------------------Depth------ ---------- --------- ---- ------------ _ Privy: Distance from nearest well------------------------------------------------------------------Distance from neardst 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--------------------------------- Dispos Field: Distance from nearest well___�Z___Distance from foundation_ _3_____.Distance to nearest of ��.e__--�------ ** "� Width of trench--- --------------------- Number of lines__________ _ ___/ 1-"" --Length of each line---------------- 74 ___________ r�_______. � X_)-Depth of filter material____- Type of filter materi r;��---'----- - 4 '` 4{ '��"" mut Y�u---- Remodeli and/or r miring scri e): - ---•--------------------------- - - ------------------ ------------------•--------------- --------------------------------------------------------------------------------------------------------------------------------------- --- I hereby certify +hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r, Iat' s of the San Joaquin Local Health District. AjSigned)';;� ----------------------- ------------------------------{Owner and/or Contractor) By:--------------------------------------------------------- -------------------------- ----- - --- - .... �- --------------------------------------------------------(Title) (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this applica+ion). FOR DEPARTMENT USE ONLY DATE-- , i APPLICATION ACCEPTED BY--------------------- ---------------------------------------------------------- ------------------------------------ REVIEWED BY-------------------------------------------------------- - - ---- DATE BUILDING PERMIT ISSUED--------------------------------------------------- ------------------------------------------------- - ------ --- ---- - -------------- DATE--_--------------------------------------------------------- Alterations and/or recommendations:_"________________ ""---------" ----------------------------------------------------------------- ---------------------------------------------------------- ---------7 ----------------------------------------------------------------------------- PERMIT No._ _7----7----- ISSUED___________ __�_3/"" _-- [Date) FINAL INSPECTION BY:_____! ! Il / - ---- ----------------------- -- Date--------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 4-50 W-1634