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y A� { < �t APPLICATION FOR SANITATION eT (Complete in Duplicate) to/ blit .; s install the wc,k;ererh described. Application is hereby made to the San Joaquin Local Health District for a permit to construct and i s e This application is made in compliance with County Ordinance o. 549. ---- JOB-ADDRESS AND OCATIO -- ---------- Y ------- Ph, e Owner's Name----- J ---- Address---------------G�'rf t 1--�+t *; ---------------- ------------------- -- Contractor's Name_------------------------------------------------ -------------------------------------------------------------------------------------,Phone---------------------t Installation will serve: Residence ❑ Apartme ouse ❑ No ❑ Trailer Curt ❑ Motel El Other Number of living units- Number of bedrooms 0 Number of baths Lot size-( -- ^ - -�r�� "` ---------•-- Water Supply: Public system ❑ Community system ❑ Private ++ Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam ❑ Clay Loam 19 Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool.permitted if public se er i I"a feet.) Septic Tank: Distance from nearest well--?.X-_ istance o'm foundation---- __�_p___.Mate I_____-- _______ ------ No. _ =�- No. of compartments ��__ ___.Liquid depth_______ ________________ P �u Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material______-_____________------__-_-______ De Depth - ❑ Size: Diameter----------------------------------------------p-- --------------- --- ---------------------------- � ' Privy: Distance from nearest well_______________ ______----_____________Distance from nearest building_______-------__________-__.________-- -- ❑ Distance to nearest lotline,_,___-`�.:_______________________________________ See a e Pit: Distance to nearest well_____ _�-�' _____Distance from Pundafic �' n-_ _0____-___.Dist nice to nearest lot line___r�""-._______ • Ver!' ------- Depth ' Number of pits------- -----____- material_ ' r�"° ------ Dispo I Field: Distance from nearest well___' 'Distance fromn__ _-_.TDistance_to nearest lot li e__ - w _ D . - _. �- "Number of'lines_____________1 _ ength of each line________ r Width of trench____ __,_-__�_______________ _. Type of filter material_ -----------1---------- pth of filter material--------___ ___ t q�. Remodeling a. d/or repairing (describ } d °--"--- -----•--------- ------------------------------ ------------------------------------------------------:------------------------------------------------------------------------------------------------------...---------------- 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 the San Joaquin Local Health District. Si ned _ / =s- r4. �,... e!---------------------------------------------------------------------------------(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------------------- - - --------------------- REVIEWEDBY----------------------------------------------- - - -----------------------• DATE �j ------------------- BUILDING PERMIT ISSUED---------------------------------- -- -1----------------------- -------------- DATE----- [, ------- -- --------------------------------------------------- r Alterations and/or-recommendations: ----- -- ------------------------------------------------• -•---------------•--------- --------------------------------------------------------------- -------------- = --------------------------------------------------------•-------------------------------------•-•----------------------------------------- --------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------•------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------- ISSUED---- D - ----�----{Date) FINAL INSPECTION BY---------- PERMIT N _11rr ::''` •---- Date-----------------10. ----� -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639