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APPLICATION FOR SANITATION PERMIT 4� (Complete in Duplicate). I Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Loca Thi s"application is made'in compliance with County Ordinance 'No. 549. r -� r !✓ '---------------------- JOB ADDRESS AND LOCATION----------1-��-C ------ - -------------- f ---------------------------------------------- ------ Phone-------------------------------- Owner's Name---------- ----------- -----�-f=-/.�.�'--- -------------------- - Address--------------------------- SS�_ � a '� l ------------------------- ------- -- -------- -- Phone_ �2--J---�7--V--- Contractor's Name--------------------- -•------ ---------- Installation will serve: Residence 0 Apartment House El Commercial N Trailer Court [I Motel [j Other ❑ Number of living units: F-1 Number of bedrooms F1 Number of baths El Lot size------1=_��___-_ ___f__� --' , f------------- __ i Water Supply: Public system P Community system ❑ Private ❑ I Character of soil to a depth of 3 feet: Sand F1Gravel E] Sandy Loam[IClay Loam ElClay ❑ Adobe❑ Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or cesspool permitted if publie sewer is available within 200 feet.) from foundation______-f-A------material___:__ f G / Septic Tank: Distance from nearest well--------- — Distance -------------------- No. No. of compartments----------- -----Capacity- -------Size__-:.K$ X 5-2-Liquid depth Cesspool: Distance from nearest well_________________Distance from foundation____-____________. Lining material-------------------------------------- s ❑ ------- ' Size: Diameter----------------- ------------------Depth---------------------------------------------------- Privy: ----- --------------------- -------- - ________-_Distance from nearest building________________________________________- Privy: Distance from nearest well____________________________________ . ❑ Distance to nearest lot line---------------------------------------------- t ____--_Distance from foundation______�__�%_-__.Distance�to nearest to - ---- -- Pit: Distance to nearest well___________ _ F , ( g '_._t_N:-_r_Size: Diameter----- ----.Depth--- ---- Seepage G� ti Number of pits--------- ------------Linin material__ Disposal Field: Distance from nearest well___________-------Distance from foundation--------------------Distance to nearest lot line_`�_�='--_-- 1 } Number of lines------ 1----- ------------------Length of each line--- C_LJ__-----— i---.Width of trench-------;.t.__------------=------- `7� Type of filter materi� - --4- -�t_-___-Depth of filter material______1__ ________ 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 ordinances, State la les a d reguI t' s of the San Joaquin Local Health District. - - ____Owner_suc�/or ontracla r r--_____ (Signed)____________________�, �I_ � 1 J ---- ----------(Title)------ 21f/L ..tee -�` '-"-------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). FOR DEPARTMENTUSE ONLY I ' DATE APPLICATION ACCEPTED BY-------------- ----------------" --/ --------------------------------------------- - -------- DATE----- ------- ------------------ --- ------ ---------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------- ----------------------------------------------------------------- ---------------•----- Alterations and/or recommen a+ions_---------------------------- -------------------------------------- ------------------------------------------------ ----------------------------------------------------------------------------------------------------------------- L. ----------------------------------------------------------------------------------------------------------- - ---------- ------------------------ --------------------------- ----- - y' -.�--- --�ate� CTION BY:_______ ---FINAL INSPE PERMIT N6,_-9—If yISSUED __ (/ Date------------ --------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California i ES-9-2M 9-50 W-1634 -