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242- 1 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 is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION___________________________ '-•_ ----------•---- Owner's Name ---- ----- ---------- Phone--- -------------------------------- -----------------------I------1- ----------- on ractor s Name-----"__------ ------------------------------------------------- ------ ----- --- --- -----I------------------------------ phone-- -------- ------------ ----- Installation will serve: Residence Q- Apartment House ❑ Commerciai ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Ej Number of bedrooms ❑ Number of baths FLI Lot size Water Supply: Publics stem Y ❑ Co1-nmunity system ❑ 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----r�-_/-----Distance from foundation----_9_" ------Material----C'r Al c. ` r- No. of compartments--------- -:______-__ Ca acit �_7�fix_ J" 1------ -----� p Y �}---Size_-----�"4 �� ;----Liquid depth--------------- Cesspooi: Distance from nearest welt_--._--____-__-_Distance from foundation-------------------.Lining material__-___-_-"_"____________ ❑ Size: Diameter--------------------------------------Depth------------------------- ------_ ------------------------ - Privy: Distance from nearest well_--.__-___--____-.-_- -------_.-"_-__-_-.......Distance from nearest buildin El Distance to nearest lot line-.-------------- g ------------------------- Seepage Pit: Distance to nearest well----------------------D�itance from foundation--------------------Distance to nearest lot line------__--"_____ ❑ Number of pits----------------------Lining material-------_---_ r Size: Diameter Depth --------------------- Dispos Field: Distance from nearest well----'ro......Distan?e from foundation__--_-'�/_ 01 Number of lines_---_---_�-_- Distance to nearest lot line--"__- p Length �f each fine--------7.T' -------Width of trench_..'- -_/-j Type of filter material-4c_ct ---- Depth of`Filter material____!__4 --------------------- Remodeling and/or repairing (describe):--------------------------- -- --- - -- --- ----- ---- - --- - -- - -- -------- ---- ---- I hereby certify that I have prepared this application and that the work hill be done in accordance wi-A San Joa uin Coun ordinances, State laws, and rules and' regulations- of the San Joaquin Local Health District, qty (Signed)------------------ (PlotBy-------------------------------------------- ------ ------ ----•-- ----- ----- ------ ------ ----- ------ --------(Title)---------------------------------------------------(Owner and/or Contractor) plans, showing size of lot, Iota+ion--of sys+em in relation#o wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ _ REVIEWED BY �- - ------------- DATE l-)_, - - o - - - 6. f-- ------- --- BUILDING PERMIT ISSUED - DATE .__S / - - -------------------- ------------- ---------- ----- ---------- DATE----------- ------- era rens and/or recommendations_ - --�-.___-_-.__-- ----•------ - - /------------------------------; PERMIT No.,�,,I_Sa__ ISSUED_ --- -`- _ - --------------(Date) FINAL INSPECTION BY:---- "-ell �=-------`'-- -------------- Date "- --- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California