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APPLICATION FOR SANITATION PERMIT- &r (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein. d. This application is made in compliance with County O inance No. 549. JOB ADDRESS AND LOCATION----- --------- -- --- ----------- V�Z,200-10------ Owner's Name E - -------- - ---------- Phone------------------------------------ Address----------------- •----- ------�---------------------------------- --------- ------------- --------------_----------------- e� Contractor's Name__ -4-�'�" - � - -------------------------------------- Phone---Or-- Installation will serve: Residence)( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ O her E]1 Number of living units: it Number of bedrooms.9 Number of baths ❑ Lot size_ . . ............ Water Supply: Public system ❑ Community system 5( PrivateV Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe X Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) qq Septic Tank: Distance from nearest we11.070 -----Distance fro foundation � _Material_.__�� ........... " � ___ ��!__ No. of compartments-------�-----------Capacity--- .��0----Size_,2 '�L_.. � Liquid depth_______-_-PZ_________-_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-____-__--_______________--__-:-____-. ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------}c.-P-�, ❑ 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--------------------------------- -Disposal ___________________-_-______.___ o . _Dis�I Field: Distance from nearest well __________.Distance from foundation-----,-?-'$ Distance to nearest lot line Number of lines_.________. _ e Length of each line.--�a�--N Width of trench_:__ _. ________-__ Type of filter material� _ _'�___Depth of filter material___.f4*_ ____ -Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------- ------------------------------------------------------------- •-••---------------------------- -------------------------.......-------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. �j- d 01 (Signed) s✓ ' ' ' -- ----- ----- - ------ ------------------- --------- (Owner and/or Contractor) y - ----------(riifle)--- ----,- -------- ---------- (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... REVIEWED BY DATE ---� ------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------.� Alterations and/or recommendations----------------------- -- - ��------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - ---------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.................. ------------------------------------------------------------------------------------------------------------------------------------ -------- ------ ----- -- ---- -- ----------------------------- PERMIT No./-40---7 57ISSUED____-r4��.'�-S -T�___(Date) FINAL INSPECTION BY_________ ______ ------------------------------- Date---------------------------- E/ ...�7- ------------------------ SAN_ JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639