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APPLICATION FOR SANITATION PERMIT ? (Complete in Duplicate) „1�struct and install the work herein described. Application is hereby made to the San Joaquin Local Health District for a permit + Z ,I This application is made in compliance with County Ordinance No. 549• ti �r1/�1:�'�aAl �- -------- JOB ADDRESS AND LOCATION------------------------�"'�--- = -- Phone'`----------- Owner's -----G-Owner's Name-------.----------------------------------------- ---------------------------- • /--------- --------------------------------------------- Address ------------------------------- Address------------------------------------------•--- -- ------- ---------- ---------- Motel ❑ Phone: --- Contractor's Name------------------------------------------------ Installation --------------- --------------------------------- ---•- -- ' '' Trailer Court ❑ �� Other ❑ installation will serve: Residence Z Apartment House ❑ Commercial ❑ �C?-•-------------------- ---- Number of living units: � Number of bedrooms � Number of baths Lot size_________ X_ Private Water Supply: Public system [Community system El Private �h Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan �f TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) r� l �'p------tMate�i I:� `a"` -'- -` ____--_Distance from foundation______ _T_ ►" Septic Tank: Distance from nearest well p O depth Liquid1 ------ --'-------------- No, of compartments__ - ----- gi ------------- th -- p --------- ------ -------•---- Dep - Cess ool: Distance from nearest well_____.-__-_____-__Distance from foundation____________-. Linin material` ❑ Size. Diameter _____-_Distance from nearest building '__----- - Privy: Distance from nearest well ------------------ --- --------------------- ❑ Distance to nearest lot line------------------------------------------------ M -------------------Distance to nearest lot line_________________ Seepage Pit: Distance to nearest well Distance from foundation iDiameter_______________________Depth______--________---___--- --- ❑ Number of pits___-__---------------Lining material______________ -- _ wrest lot line__------- 11 Dispos Field: Distance from nearest well____'-------Distance from foundation____I___________-Distance to nearest ` _ 4-- -- ch" Nu ebof filter material 06-_, offf filter material_� g ° "_.W�dth of tren' Type �'. ---------- ------------------------------------- -------------------------•----------- Remodeling and/or repairing (describe):------ ------------------ - ---------- ------- ------------------------------ ------------------------------------ ------------------- - ------------------- -----------------------�- - ------------ ------------- -- -- -- �s,1_ -C�s�a" 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. ___ ------------ and/or Contractor) I ------ -- -- -- -- --- � ---------[Title) :----------- ------zaPPlication). (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this FOR DEPARTMENT USE ONLY �' DATE �" --- --------------------- APPLICATION ACCEPTED BY------------------- --- II —r -�- J- Jll "-J DATE-------------- --=' ----- --- APPLICATION ------- ----------------------------- REVIEWED BY-------------------------•------- ----------------------------------------------------------------- - --------- -- 11 BUILDINGPERMIT ISSUED --------------------------------------- DATE---------- ----------- ------------------- ------------- Alterations and/or recommendations:---------------------------_ ----------------------------------------- -------------------- _ __ -------------------------------- - -- - - --------------------------------------------- --------------- ----- --------------------- -------------------------------------------------- ------------- - ------------------------ ---------------------------------- - ------------------ -------------------------------------------------------- --------------- --•- ---------------- - ------- --------------------------------------------------- {Date) FINAL INSPECTION BY:------------- - ---------------- PERMIT N#'T-�---------- ISSUED_-- 1 •�`� - � '" -- ate------------- ----- - �t ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1634