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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. 54 JOB ADDRESS AND LOCATION___,3__'/____2__9 ---_-_-- --- - ------------------------------------------------- Owner's Name------- ' _ ��_. ,-w � 1_# =-t- -------------------------------------------- ----------------- Phone---- x w Address -- Contractor's -------------------------------------------------w ------------A- - one pp Installation will serve: Residence El Apartment House' ❑ Commercial ❑ . Trailer Court ❑ Motel,❑ Other ❑ Number of living units: ❑ Number of bedrooms.I] Number of baths C] Lot size-------6Dx115-------------------------------------- Water Supply: Public system ❑ Community �system ❑ Private ❑ s Character of soil to a depth of 3 feet: Sand Gravel f P ❑ ❑ rSandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [❑ Hardpan ❑ + ' TYPE OF INSTALLATION AND SPECIFICATIONS: ,t. V , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well�1__'f Distance from foundation_"-_* �__.MateriaL ___.___--_=`""' ,. n ------------------------- No. of compartments-----`-----------------Capacity-- --- - -size_'-VI-=� Liquid depth _5 1 -- Cesspool: Distance from nearest well---f___!------Distance,from foundation--',,------ Lining material-------------------------------------- 0 Size: Diameter---------------------------e---------Depth--------------------------------------------------- Ir Privy: Distance from nearest well---------------------r--------------___--__-----_Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------------------------------------------'-- I Seepage Pit: Distance to nearest well----------------------Dista- e from foundation--------------------Distance to nearest lot line_- EJNumber of pits----------------------Lining material-------`--------------Size: Diameter------------------------Depth------------------ ----__-_--.._ --------- r i w Disposal Field: Distance from nearest well_------''__'-*rDistance from foundation--------------------Distance to nearest loft line__•- _ ❑ Number of lines------- ----_-- ------Length of each line--��_--,�-8-`-_-.Width of french-------2-_'----------------------- Type of filter material �IS--------Depth of filter material-------- ��______-_ Remodeling and/or repairing (describe):------------------- -_----- ----- ------------------------------------------------------------------------ --------------------------------------------------------------------------------•------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County w� ordinances, State laws, an rules and re ulations of San Joaquin Local Health District. (Signed)---------------- ---- --- ---------------- -------------(Owner and/or Contractor) BY*- --------------- --- - Ti+le - - - - - - - ------------------------- - - --- - ------ -------- ---- - ---------- ----------------- (Pl ot 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----- 3 d" BY------------------------------------------------------ -------------- -------- ------------------------------------------- DATE---- -!--- ---j--�-------------- -------------'- BUILDING PERMIT ISSUED --------- -------------- ------------------ ---- DATE Alterations and/or rgcommendations:---- :----- - ------------- ----- --- --------- --------- -� �� -- --.t .- �_-- ! --- ; -------------------------------------------•-------------------------------------------------------- ----------------------------------------------- -------------------------•-----------------------------_-•-------------_-_-----__--_-_-_ - -- n' v PERMIT No.---------- --------- ISSUED------- - Z- (Date) FINAL INSPECTION BY:--------ALI/----ii Date------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W=!634