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�r6 f 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-------------g_ _ _________ ' Owner's Name---------- .-------------- -------------- ----------- ---------- Phone--- • f" ' Address-------------- _'7 P-# s -------- "- ---------------------------------- ------------------------- --------------------------------------------- Contractor's Name------------- r``' Phone _ --------------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [fl Number of bedrooms ® Number of baths r� Lot size____-_' l�_-- ______ � Wafer Supply: Public system ❑ Community system 0 Private ® Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑� 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------------------------------------------------- from nearest building g -----------------------------' 1 ❑ ' Distance to nearest lot line -__-----------_- p � � g ----------------------- - ��r�------ nearest lot line___;_"__________- A Seepage Pit: Distance to nearest well----- _�_--_-_ -__Distance from foundation______________ ____ Number of its------- -------------Linin material____.----_-_---- _.__.Size: Diameter____Distance to Depth----_-_---�_ -----_____-_---" lDisposal Field: Distance from nearest well-----Iva-- Distance from foundation-_-/�________Distance to nearest lot line___;__-_--__ QNumber of lines-----------1--------------- ----Length of each line------ -A -I---Width of french--------R-Y-0e---------•-- Type of filter mate rial-__4th_ 6 4 K_Depth of filter material-__--_.1il-0-------- Remodeling and/or repairing (describe):----------- P &%,,; ! --------------- -- ---- - ----------------------------------------- ----------- -------------------------------------------- - ----------------------------•---------------------------------------------------- --------------------------------------------------------------------- --------------------------------- ------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sffaafe_laws, and rules and-regulations of the San Joaquin Local Health District. l (Signed)-------- __A__1 ------------------------------------------------------ C-1 (Owner,and/or Contractor By--------------------------------------- -----------------------/---------------------------------------------------------------(Title)------ ''�' "� (Plot plans, showing size of lot, location of system in relation to wells, buildings, efc., must be filed with fhis applicafion). FOR DEPARTMENT USE ONLY € APPLICATION ACCEPTEDY-_ ---- - DATE_.---( / "L? REVIEWED BY d - - ---------;•= ---------------- --- ------------------------------------------------- ------ - --------------------- --------- DATE---- /t--1 r BUILDING PERMIT ISSUED--------------------------------------------------------------- ------- DATE-------------------------------- �endations: ------------------------- 9.m Alterations and/or rec' d t r - !_s �' --`!--•- ?rr"t-_fin.-��__ '-- - - ------------------------ ------------------------ - svr,�ti -�a4_r-_,"04-#-a--1I�'d---f)_s lm__ 1 a� ------ -ax- ---A_dA-e__d,--------- - A- ( ` ! Yse u��r-bit` -------------- -------------------------------- PERMIT Nc,_�_6_ ----------- ISSUED---LL-- --7- �` ----------(Date) FINAL INSPECTION BY----------- --+ -� ----_----------- Date--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1634 • ,,, �' '