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2� ( 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_ _ �'� " �1 -- ------------------------------------------------------------------------------------------------------- Owner's Name 1 Phone-- ;-4 3/4 ----------------------------------------------------------------------------------------------------------------------- ----------------- --- ------------------ Contractor's Name_____ _ - -- -- - - _ ----------------------------- ---------------- Phone-- -- .; Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel a Other Number of living units: ❑�Ommunity -of bedrooms ❑ Number of baths ❑ Lot size______________ ❑ Wafer Supply: Publics stem [Y system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ar pan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: %v (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W Septic Tank: Distance from nearest well_ . -_ -- � � \kA � Distance oution_____/ -MaterialNo. of compartments_-_.______ Capacity � __ ( -n -------- ze----------- uid depth � _____________Cess ool: Distance from nearest well-----------------Distance from foundation ❑ Size: Diameter--------------------------------------Depth---------------------------- - _.Lining material-------------------------------------- ❑ Distance to nearest lot line Privy: Distance from nearest well___________________________ ___________________ ............Distance from nearest building---------------------_.................... _____________________________ Seepage Pit: Distance to nearest well_____ ______Distance from foundation--------------------Distance to nearest lot line___ Fl Number of Pits----------------------Lining material____________ -----------Size: Diameter------------------------Dept h-------------------------- ------- � Disposal Field: Distance from nearest well___ __.Distance from foundation._ / a Number of lines_______________';' : Length of each line__ ' Distance to nearest lot line_____._.. Type of filter material--- Depth of filter material___________ - ---�---- ._-Width of trench__ �__ Remodeling and/or repairing (describe)---------------! 0 --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed)-------------------- ----- -- gy: (Owner and/or Contractor) ' -----------------•-----------------------------------------------------------------(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___ __________ _ _3 REVIEWED BY - --------------------------------- ------ DATE------ n -•.. BUILDING PERMIT ISSUED ________ ____ ATE - ------------------------------ _ Alterations and/or recommends+ions:___________�� ---r - ___ � __ '_:= :: _=dc4====---------------------------------------------- --------------------------------- ---------- -------- --------------------------------------------------------------------- --------------------- PERMIT No.-----7,54-. _ ----------------------------------- ISSUED_-__.�___J� --- -_ __ (Date) FINAL INSPECTION BY:____ `��' V ---------------- ------ 4------------------------------ Date ... -------•---------•-----•- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California