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' 3�5 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 LOC ION ©5 ---------- ------- ------- �-16._!_.�3�---------------------------------- Owner's Name-.. -L-!-[9� �Y v"_ -------------------------------------------------------- Phone----------------------------- Address ------------------------•--- f � `� - Contractor's Name_------------e--- ' Wet ( 17 -Y1">ii 11�GQ�. Phone = Installation will serve: Residence YAparfinent House E] Commercial ❑ Trailer Court ❑ Motel Other Number of living units: j Number of bedrooms 5� Number of baths t Lot size------------- 1 �� Water Supply: Public system`❑ Community system ❑ Private Wf Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: r ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.)f Septic Tank: Distance from nearest well__ pq-----.Distance fro foundation-_-101Iv�aterial------- No. of compartments. ---------Capacity_ _ +- ---Z)__---Size--- '-----------------------Liquid depth-- ------ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material----__---__-_------__ Size: Diameter--------------------------------------Depth---•---------------------------------- Privy: Distance from nearest well----------------.--------------------------------Distance from nearest building------------------------------------------- El Distance to nearest lot line____________________________________________ r 5eepa Pit: Distance to nearest w II_-__- + -----_Distance f('om pundation---_z -------Distanqto nearest lot li ° {�-----�_------- Number of pifs----------------_---_Lining material____JrJC 1-k-----Size. Diameter_-_.__- Disposa reld: Disfance from nearest will--Liv- -----Distance from foundatio Distance to nearest lot line._-- --__ ��I Number of lines______________ _ _ ---------- Depth of filter material E' -- /(�_ Remodeling and/or repairing (describe)----------------------------- --------------------------------------- --------------- -------------------------------------- Lvi- -- '' , ` '`� ` '`" r .�-- ------------ ----- ------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lows, ayd,rufe d regulations of the San Joaquin Local Health District. (Signed)-------------- - ------------ -------_-------Owner and/or Contractor) By:-------------------------------------------------- -- - -- ------------------------------------------------- (Title) ------------ --------- r. ; - - ---------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- -- DATE-------- ----��--- -- REVIEWED BY Q ----------------------------------------------------------------- - =------------- ---------------------------------------------- DATE BUILDING PERMIT ISSUED----------------------------- DATE-------------------------- -------------------------- Alterations and/or recommendations------------------------------ -----------------/------j---�--------------------------------------•------------ PERMIT No----- I_._q----___---_ ISSUED---_ '-`� -_ .___________(Date) FINAL INSPECTION BY:-_`_.(�-F-'__� ----- -------- ----- f Date-------- - -- -`��--- --�-eF---� ---•----•-• SAN JOAQUIN LOCAL HEALTH DISTRICT F 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California