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0 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 ;s made iii compliance with County Ordinance No. 549. 117�' JOB ADDRESS AND LOCATION--------- Owner's Name-.------- Address - ------- ------------------------ Phone Contractor's Name_ ----------------------------------------------------------- ------------------------- ---------- ------- Residence Apartment House ❑ Commercial El Trailer Court E:j Motel E] Other Ej Installation will serve: --r------ Phone--- Number of living units: 7 Number of bedrooms [I Number of baths Ej Lot size..-J- Wafer Supply: Public system El Community system [:] Private --- -------- Gravel E] Sandy Loam 0 Clay Loam E] Clay El Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-.________.___ Distance from foundation------------------- Material----------------------.-----_--- ❑Cesspool: No. of compartments------- ------------------Capacity------------------------Size--------------------------------Liquid depth---------- -- ------------ Distance from nearest well-----------------Distance from found6t' F1 Size: Diameter 'on-------- - -----..-Uning material--____._____.-___------------------- -----------Depth-------------------- -------- --------- Privy: Distance from nearest well___-------------_ ------Distance from nearest building---------- --- ------ ------------------ F] Distance to nearest lot line ---------- Seepage Pit: Distance to nearest well_- ____-__-__-Distance from foundation------------------- Distance to nearest lot line ❑ Number of Pits----------------------Lining material_-_._____.._-_.--------Size: Diameter__.__-____-____ Depth----------- i ,�—O'_ ---------------------- Disposal Field: Distance from nearest well__Y_s Distance from foundation_ # an---��?------------Distance to nearest lot Number of Iines .____e)tline-____ !J'_" ---------Length of each .&II --------- Type of filter Depth of filter Width of french --- -------------------- Remodeling and/or repairing pscribe):----------- --- ----- ------- ----I------ -----------------I--------------------- ?) --- - --- ---- , " - --------- ---------------------------------- -- ----- ----------- ------------------ --- ----------------- ---------------- --------------- --------- ------------------------------------------------ -------- ------- - -- --------------------------------------------------- -------------------------- --- ---- 5Z 1 hereby certify that I have prepared +his lication and f the work will ----------- -- - - ---------___1-------------------- ordinances Stat I "'" 0 T il be do in accordance with San Joaquin County d egula State pi and rules and re *n of the San Jo uin cal Health District (Signed) �e--40------ - ------:_ W-1 t --[Owner a /o C �r�C +rac+or) if ---------- 'fie)------- ------- --------(Tj (Plot plans, showing siz f lot, location of system in relation f wells, buildings, etc., must be filed ith this application)- ------------------ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED REVIEWEDBY ----------- -------- --------- DATE--- ----------------- -- - ---- ---I -- ----I --- ----I--------- DATE-_ BUILDING PERMIT ISSUED_______________________ ---------- --- ------ ------------- ------------------------------------------ ----------- -i----- ------------ D TE ------------------ ------ -------------- Alterations and/or rec9mmendafion! -- --------- --- -----;---------------- ---------A7 � Lr-�w '_ - ------------- C"------ -- --------- - --- ---- --- -Rot ----------------------------------------------- ------------------------------------------------------;_7- ---I--------------------- ------------------- ------- -- ----- ----------------- ------------- ----------------------------------------------------------------------------------I----------------- ------------ ----------------------- ------ ------------------------I--------------- --- ------------------------------------------- --------------------- ------ -------- - ------ ----------------------------------- PERMIT Na..--- kIA-------- ISSUED R_—;71b -�S j -----------(Date) FINAL INSPECTION Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California