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APPLICATION FOR SANITATION PERMIT l (Complete in Duplicate) S/�w,/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor erein descr ~ This application is made in compliance with County Ordinance No. 549. bed. JOB ADDRESS AND LOCATION_._. Owner's Name---------ll--_L-r --' ,F I Phone-- - -� Address--- F2 Contractor's Name................................... / ..._------ - - -----------------------------P--h--o--n-e- ---------------- - -.. Installation will serve: Residence Apartment House ❑ Commercial ❑ ,Trailer Court [ Motel ❑ Other ❑ \\ Number of living units: ❑ Number of bedrooms k? Number of baths Lot size_------- 0 �--_- Wafer Supply: Public system ❑ Community system E] Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ' Adobe Hardpan ❑ 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._,5'0_---Distance from foundation___. O __.__Material__.-: No. of compartments-----.------.2..._____.Ca aci 00__ „� x ��/ Capacity Size ---- -r q------Liquid depth------- ------ Cessp ol: 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-------------_._ ❑ Number of pits----------------------Lining material.------------- Diameter.___-.__._-____---Depth---------------------...__------_ Dis os Field: Distance from nearest well__-$- '._.__.Distance from foundation---e�o+........Distance to nearest lot line.__S�O.Ul '! Number of lines----___------------- _----Length of ash line__-._.__�_;z0----_---.Width of trench------z1ON---___-----_- Type of filter material...1-01-A..--.---Depth of filter material----.-/8.11....___ Remodeling and/or repairing (descri e):------ _._ ._.. .____.._-. -_.... —r = ..__ -t:-4A---- --------- - - - - -------------------------- ------------------------------------------ I herebyy certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Late laws, and rules.And d regulations of the San Joaquin Local Health District. . (Z (Signed).__.___XI_____ _______________________ (Owner and/or Contractor) By:_-------------------- ---------------- -------------------------------- ------------- ------------------------ (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY. _ -_ DATE___O. _..T.- REVIEWED BY------------- - - - - -- - -- DATE. )_ BUILDING PERMIT ISSUED_.___-3`�___._� 3.4_ ---------- - - -' DATE -'04- �--'S� - Alterations and/or recommendations:_----_---_----------------------------' - --------------------------------------------------------- -- -------------------------------------------------------...............'----------------------------------------------------------------------------------------- ------------------------------------•-- ----- ------------- --------------------------------------------------------------------------_--------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ----------------------........----/--�------------------ -- ------------------- 1�... ISSUED...._/.-._�__ 5/---__(Date) FINAL INSPECTION BY: ... PERMIT No._--�_� �1� -------------- Date ------ Date-- ------------------ SAN ---------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639