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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�insta.11 the work herein described. This application is made in compliance with County Ordinance 49. �, I lJ . JOB ADDRESS AND LOC TION____(_ .-- _____ _ �- : Owner's Name--- - -- ------------------------------------------------------ 1& Phoneme "� Address ` - ---------------------------------------------------------------------------------------------------------------------------------- Contractor's Name___ y y Phone-- --------------- Installation will serve: ResidenceK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ of living units: Number of bedrooms , Number of baths Lot size--.470- Number3 X -- r -- Water Supply: Public system;K Community system ❑ Private ❑ j Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)I Hardpan ❑ TYPE OF INSTALLATION AND SPEC[F[CATIONS: (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--------------------.__-.___-_-___-_-___-. ❑ Distance to nearest lot line-----------------___________•_________________-_ See a e Pit: Distance to nearest well ?"' _Distance from foundation__ o-______.Dista cue to nearest lot line____________ Number of pits---------/-________Lining material__ ,. Size: Diameter_______3 ________.Depth_ "':•�*z____ /l Disposal Field: Distance from nearest we[I -Distarsce from foundation______ _______._Distance to nearest lot line____l,�_.___._-_ Number of lines______________ Length of each line___jk_`__--------------Width of trench_____ __"_________ Z- Type of filter material.�Y---��s---Depth of filter material__- 2--"�___ Remodelingand/or repairing (describe)-------------------------------------------------------------------------------------- ------------------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------•----------------------••------------------•-------------------------------------------------- --------------------------------------------------- ----------=---_-------•------------------------------------------------------------------------------- ---- a ------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- ` 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).... =-•--- --- { -------------------------------------------------- - -- /or Contractor By:----- --------------------------------------------------------------(Title) -- 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 /tSS��-------------- REVIEWED BY. - - - - •-. DATE----- BUILDING PERMIT ISSUED----------------------------------------------------------=--------------------------------------- DATE----------------------------------------------------- Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- --•----•----------------------------------------------------------------------------------------•--------------- -------------------------------------------------------------------------------------- ------------- --------------------------------•------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------.•- _---------- PERMIT No------i"A'A--------- ISSUED---- -------------(Date) FINAL INSPECTION BY:--------V±__--�__--- ----------------------------- .. Date-------------------I--------U------S71-------------------- SAN • --1----------------_-_- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9.50 W=1639