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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. x r '�� ----------------------- i� ADDRESS AND LOCATION__ '� � --�------ --- ----- --------------------------•----------------------------------------- -----------•--------------- JOB Owner's Name----- x -C J-`' = Phone Addressr_ r -- ------------------------------------------------------ 10 Contractor's Name--�llA...... :----------------- ----------------------------------------------------- Phone-�' �c.r Installation will serve: Residence's Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -it +Number of bedrooms Number of baths Lot size---Z, --"�_-X-f a„ --------------------------- ' Water Supply: Public system �& Community system ❑ Private ❑ g Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Dk Hardpan ❑ IL R TYPE OF INSTALLATION AND SPECIFICATIONS: x (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep Tank: Distance from nearest wel � Distance'from foundation-,___/�-------.Material____C"-10,44A------- i---_------ No. compartments-------- Capacity_--V _p------SizeE "�- _ ----------Liquid depth__Aj. ________________ Cesspool: Distance from nearest well-----------------Distance from foundation_____ __'_ Lining material___________________- ❑ Size: Diameter---------:--------------------------- Depth - ---7---}-------- ------—--- :Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_____-----___.__________________---____. ❑ Distance to nearest lot line------------------------------------------------ ` ` Seepage Pit: Distance to nearest well_%...r- ______Distance from foundation____4'6__J___.Distance to nearest lot line__�6_------- 1. lam' Number of pits--------%------------Lining mate -Size: Diameter_____.j,,e-----------.Depth_____�.�?_'_________------- ,.Disposal Field: Distance from nearest well__ ------.Distance from foundation----/a `_---.Distance to nearest lot line_-__!_L--- Number of lines---------- ____ Length of each line_______f�}r _�___:_ Width of trench____�_( ---- Type of filter material--f_ __._, _�__Depth of filter material_____fi?._------- Remodelingand/or repairing (describe)------------------------------------------------------------------------------------------------------------------------------------------------ ------ --------------------------------------------------------------------------------------------------------------•-------------------------------------------------------- --- - -------------------- ------------------------------------------------------------------------------------------------------------------------------------------- .. ---I-------------------------------------------------------------------- -------------------------------- ---------------------------------------------------------------- I 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 +he San Joaquin Local Health District. y L ! 1 Si ned /or Contractor) (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 v; APPLICATION ACCEPTED BY --- DATE Lf ^ fes f REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------- DATE------------------------------- -------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------------------- Alterations and/or recommendations------------------------------------------ --------------------------------------------------------------------------------------------------------- ---- --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ ISSUED--- 1 - -.5�-------------(Date) FINAL INSPECTION BY:----------- ___U---e-------------------- PERMIT No-4— o.` j_ _ ------------ 1 , � �r Date---------------------- ? 1-------------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W-1639