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3.77 APPLICATION FOR SANITATION PERMIT I (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.rdVA4_C JOB ADDRESS AND LOCATION----11-2-2-----G! AAL--- -------------------------------------------------------------------- Owner's Name---- ---------------------- -------------------------. Phone----------------------------------- Address....U-z----- -------------------------------------------_------------ Contractor's Name------ i �__ � �- ,� --- -'='�=-�e"---"-!L,.---------- -------- --------------------------------------- Phone-- -1-4-f'-�-2----/-- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑/ __ Mot 171Other W A/4[e..� Number of living units: Number of bedrooms Number of baths Lot size___/- __._.3Q�"` a Water Supply: Public system ❑ Community system ❑ Private x N 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_________________Distance from foundation--------------------Material--•-___-_____________________-________________-- ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth------------------------_ 'Cesspool: Distance from nearest well-----------------Distance from foundation___________.•.___-Lining material-___-__________-______________-_____. ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 171 Distance to nearest lot line------------------------------------------------ Se epa a Pit: Distance to nearest well---1f p__t_Distance fromfoundation___/dO...-Dist nce to nearest lot line Number of pits---------`----------Lining material•____ t__r___Size: Diameter____ _`__.Depth------140__�_______________ _Disposal Field: Distance from nearest weN ' t3istarrte•from foundation Distasree to nearest lot line " Number of lines___ ___._/_______,___��..- -_. Length of each line........1`1J!.. Width of trench___.__ _ _' ............... Type of filter material__L;C___,e*.Depth of filter material.__-_ -Remodeling and/or repairing (describe):---------------------------------------------------------•-•---------------------•-----------------•-...................------------------------•----- --------------------------------------------------------------------------------------------------------------------------------------------------------------------.....................----------- ----------------- •--------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I 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. �j /� "�". (Signed).-ORA7 t--`�, �.�r--------- -------------------------------------- W or Contractor) BY:-•---•�l?Fl�! Z -- ---- ----------------------------------------------------------------(Title)- - . ---------------- (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_____ _Y_ =.________ _______________ DATE_______ -__."'_�_�f_ __-•__- ----------------------------------------------------- ----------- REVIEWEDBY `v� ----------------------------•----------•------------------------•------ HATE.------3- -/-- � - —-------------------- BUILDINGPERMIT ISSUED-------•--------------------------------••••------•--------------------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations-------------------------------------- ---•---------------•--------------------------------•-----------------------------•----------------------------- --•----------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------•-- ---------------------------------------------------- ----------------------------------------------------------------------- --------------•-------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------7------------------------------------------------------------------------------------ -••--•--•---------•------------•-•------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------- •--•••......--•- . No.... 7_Z._._..._._ ISSUED_________ _______•________5__-____---_(Date) FINAL INSPECTION BY:___�___-.._-'__--•___ ---------------------------------- Date-----------------------3-"=-- ~---I----------_----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639