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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 and ins all the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND COCATION.____ o /J- ---- <Al d_P _t.�1ftQ — -� Q- �i�i�c!c!a�J C�= -� /'Te---L---- @) Owner's Name �r1��s3 �-= �/4'1� - Phone----'Z 2 Address--------------/Of -------C....... ° Contractor's Name-------------------- ----------------------------------------------------------------------------------------------------- Phone-- ---- ------------- Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [P Number of bedrooms EJ Number of baths ❑ Lot size------0_J___K._Z/_6_________________ Water Supply: Public system ❑ Community system ❑ Private ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam N Clay ❑ Adobe❑ Hardpan Cj < 4 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----SO......Distance from [ _foundation-___----1Q � _ :___.__ No. of compartments----------�_ ------Capacity-----�'D_0-.----_-Size.__tk5'y--- .�..Liquid depth-------+f - ------- Cesspool: Distance from nearest well•_--•______•..___Distance from foundation--------------------Lining material---------------------------------- 171 Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------- El ____________----_.---_-_---____ -_.❑ Distance to nearest lot line_______•________________________________________ et Seepage Pit: Distance to nearest well______________________Distance from foundation....................Distance to nearest lot line___...__ ❑ Number of pits----------------------Lining material-_____________________Size: Diameter------------------------Depth.........._-__-_--_._... ..Disposal Field: Distance from nearest well...._-47Q.__..Distance from foundation......%P___--------Distance to nearest lot line_._!Q [$ Number of lines...........*OL-------------------Length of each line......cQQ. ._a'd^..Width of trench. -____?._________________ - / Type of filter materialAs.-- "-rDkk...Depth of filter material_.-__./e".._.-- ._ a 'Remodeling and/or repairing describe •______________4.Q-W_.___..�.l�tJ__�-�f_I_rr_i4 - - __- `" ------------- ------- -•-----------------------------•-----------------------------------------------------------------------------------------------------------------------------------------•--------- I► I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Cou ordinances, Stat la and ru s and regulations of San Joaquin Local Health District. �s (Signed)----- ---• . - -- -----•- ---- ------_- - - -- ------- ------------------------------------------ ----_------------------(Owner and/or Contra cfofx By:--------------------------------------------- -------------------------------------- --------------------------- -------------(T'ifle)----------------------------------------------------- ----- J (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----- REVIEWEDBY----------------------------------•---------------------------------------------------------------------------_----------- DATE----------------------------------------------------- .._. BUILDING PERMIT ISSUED-------------------------------------------------- ---------------------------_--_---------- DATE------------------------------------------------------. Alterations and/or recommendations:----------------------------------------------------------------------------------------------------------------------------------- -----------......... •--------------------------------------------•----------------------------------------------------------- •-•---•-•---•-------------------------------------------------------------------------------------------------------------------------------------------•--------------------------..................---------------- -•-- •-•-••••--•-•---•-•••-•--•------•-•-----•-•-•••-•--•---•--•--•--•----••------•----•-•--•----------•--••---•-••----•---••--•-•------------•-•---------•------•---•••-•----•----------------- ----------••----------•-------- --------------------------------------------------------------6---- PERMIT NoIP___/ 1_-_-_. ISSUED_.• /..3 _.._ `�____.......(Date) FINAL INSPECTION BY:_ _-_/1 �!'_ ________________________ Date-------_-E' ..a g �__ L-. SAN JOAQUIN LOCAL HEALTH-DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639