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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. t !+ - JOB ADDRESS AND LOCATION-------- -I-------- f w� -`-----flo l-t------------------- �k ... h --------------- Owner's Name----------------------- m1 S--f--------- ---- -Iywn--------- ------ -------------- -- Address---------------------------------------------I -------- ---------------------------------------------------------- Contractor's Name_-------------------------------��.�� -------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence E] Apartment House El El❑ Trailer Court [:] Matel [I Other ` . aa__ -Number of of living units: E] Number of bedrooms 11 Number of baths (j] Lot size___.C�___________________ Water Supply: Public system ❑ Community system ❑ Privatex Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam' Clay Q Adobe[j Hardpan L] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material.________---__________---__________________---_- ❑ No. of compartments--------------------------Capacity.----------------------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_____-_-- -______---__________-_____- ❑ Distance to nearest lot line------------------------------------------------- Seep9ge Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line--.___________-_ ❑ Number of pits-------•--------------Lining material.----------------------Size: Diameter------------------------Depth--------•-----------------.------ Disposal Field; Distance. from nearest_well------50-----Distance from foundation-----/_I2----------Distance to nearest lot line_,___S___--____--��- Number of lines------_�----_t_•------------Length of each line._3010% �P1Jo_-Width of trench------------ `--------------- Type of filter material______ _1__ V4__Depth of filter materna Remodeling and/or repairing (describe):--------------- � " � � --------. Lia-----•------ l - ----------- ------------------ -- - ----------------------- ------------------------------- ----------- --------------- ------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- 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)------�---- ----- --- ----------------------------------------------------(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 application). FOR DEPARTMENT USE ONLY ------------------ APPLICATION ACCEPTED BY------------------------------------ ------ -- - - --------------------------------- DATE-------- �j� REVIEWED BY--------------------------------------------------------------------- DATE-------------------- --=: --------- ------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ DATE Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------I------------------------------------------------ --------••------------------------••-------------------• --------•---•------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- - -------- •-----------•-------------------------------------- ------------------------------- ---------------------------------------------------------------------------------------------------------------------- PERMIT No.____ -.�_______ ISSUED ~`z ` ----- ------(Date) FINAL INSPECTION BY:------- --�- ------------------------------- Date � r- - 1 � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M '9-50 W-1539