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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct an install the work h ein described. This application is made in compliance with County Ordinance No, 549. / �f, > Z` ---- --- f n ,1 ' Y' ��`��'"" Owner's JOB DName S AND LOCATfONQ_--_----_ a `` T ---- ---------- --------------------- -- Phone- Address �� .1tj°__G✓c' Contractor's Name- ---------------------------------------------------------------- ------------------------- ------------------ --- ------ -�`,,� "----- ------------------- - --------------- --------- - ------- - --- --------------------- ---------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: [] Number of bedrooms] Number of baths 0 Lot size------------ I O Q ❑ ------------------ Wafer Supply: Publics stem Y Community system [-] Private (] Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ C1ay Loam ❑ Clay ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepTank: Distance from nearest well__'SG�__Distance from foundation____-_--' Material__-_/ t-"�?r /0 c. No. of compartments-------_oL_ (� 3 ---------Capacity------ - Size -SSC f -----Liquid depth-------� �� Cesspool: Distance from nearest wolL_-___..______-_Distance from foundation--------------------Lining material------------------------------------- Privy: -_-__------------ ----- ___ ❑ Size: Diameter---- ---- --- -- �---- - �----.Depth---------------------------------------------------- F ---- - -- - - - --- ------------------------------ Privy: Distance from nearest well______________ ....________---._Distance from nearest building-.. ❑ Distance to nearest lot Zine-------------------- __ ----- ----------------- ------ Seepage Pit: Distance to nearest well-----�0._ -- __ �_ Distance from foundation--------------------Distance to nearest lot line___I�-`' Number of pits----- ---- ------Lining material-_---- ------_-----,Size: Diameter---4� */q!,¢_.Depth--------- --y-------- Disposal Field: Distance from nearest well { w �_.___- -.D�stance from foundation_._ZS__,-__-Distance to nearest lot line ___S-_� Number of lines-------- Length of each line________3_Z I x 9 --------Width of trench-------�-�...-- Type of filter materiai__, _ _Depth of filter material____-___/ "--__ --------- Remodeling and/or repairing (describe)__________________ _ ---------- -------------------------- --------- ---------- -- ------------------------------------ --------------------------------------------- ------- ------------ ------------------------------------------------------------------------------------------------------ I hereby cerfify , t I ha prepared this applicatioryryaiid that the work will be done in accordance with San Joaquin County ordinances, Sta}e laws, and r I and' regul ns of th�SSn Joaquin Local Health District. (Signed)-- --------- -=-x---- , _... r ---- -- -----------------------(Owner and/or Contractor) By:--------------`-- ------------------------- (Plot plans, showing size of lot, loca}ion of system in relation to wells, buildings, efc., must bfeefiled with this applicafion). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWED BY--- �-- -- - ------------ -- --------- ------ DATE--------1f ------------``- - ----------- -- ---- - ---PERMIT ISSUED_. 1�:%:�_s_.: - ----------------- --- DATE_.- �=-------------------- ----------- ----- DATE------ Alterations and/or recommendations _--- -- -------------- - PERMIT No--------- --Y--------- ISSUED -----(Date) FINAL INSPECTION BY:-----;Y'_-_-1 'j , . . �.>' Date ------------- ----------------------------- SAN ----- ----- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California