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APPLICATION FOR SANITATION PERMIT �. (Complete in Duplicate) 3y i Applica#ion 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 LO ION____: ---- - ---- ----------------- Owner's ---------- Owner's Name-------------- ------ -- ------- - - ------------ ------ -------------------------------------- Phone--- Address-------------------------------------- -- ------e,5___,46Z --- ---------------------------------------------------------- Contractor's Name----------------------------- ------------------- ------ ---------------------------------------- - -- ----- --------------------- Phone Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court I] Motel ❑ Other ❑ Number of livin units: Number of bedrooms Number of baths Lot / / g m � size----#�-��-/�5 --------------- - - ------------ Water Supply: Public system ❑ Community system 1K Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ 'Adobe ❑ Hardpan ❑1 TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer'is available within 200 feet.) ` µ Septic Tank: Distance from nearest well_________Mstance from foundation----/A_/___._Material._-_ _ No. of compartments-----------�-----Capacity-------Q0--------Size---- -'- _--_ --------Liquid depth-_ ---•------ Cesspool: Distance from nearest well ---_______=__'Distance from foundation--------------------Lining material-----;--------____________._____ ❑ Size: Diameter--------- ---------------------------Depth---------------------------------------------------- Privy: Distance from nearest well_______________________________________ __Distance from nearest building__- __________________-___---___ ❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------------- El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth----------------------------- Disposal Field: Distance from nearest well--��___.Distance from foundation_____ _!�__�___Di'stance to nearest lot F Number of lines-------------/-------------______Length-of eachD_!---------Width of trench---------2-__i---------------- Type of filter material___ fir.� Depth of filter material-_____!.e_4.--___ ._ Remodeling and/or repairing (describe):----------------- -------------------------------- ----------- - -- --------------------- ------------•--------•-•---••----------•---------------•------•--------------------------------------------------------------- ._�• ----------------- ------J -� -- - --------------•- ----- .Ira E ___- _ _----------- ------------------------------. I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin C ordinances, Stat s, and rues an regulations of San Joaquin Local Health District. (Signed) ------ --- ---- -------•--- --- ---- -- ------------ ---------------------------------[Owner and/or Contra By: ----------------- - --- ------------------------------------------------------------------------( )-------------------------------------------------- (Plot ,application).Y• Tale plans, showing size of lot, location of sys em in relation to wells, buildings, etc., must be filed with this a lication. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- .V �� DATE---- /l~ '� REVIEWED BY------------------------------1 V ' "' DATE lf= BUILDINGPERMIT ISSUED---------------------------- ---------------------------------------------- -------------------------- DATE Alterations and/or recommendations: , !� ' ® --- � _0, -- ----------------------- �b r f5 - t ------ ----'---- ---- -- --------- -------- --- ------- ---- - - - - ---------------------------------- PERMIT - - - ` .� PERM_IT No.__l-0--------------- ISSUED--------- ---------(Date) FINAL INSPECTION BY:--------ki--- --lam___----- (C --------------------------- f` TDate------------------ -----------------r` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street �, M Stockton, California ES-9-2M 4-SD W-1639 1� °