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� 3yc 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 N 549. JOB ADDRESS AND LOCATION_-__/p._-Z/_________ ---_ �o -------------------------- ----------------------------------------------- ` .` -f'E� -- - Phone_ _= Owners Name._.. _43__�7------- Address.--& ----- v Contractor's Name------ -- ---- ' ,SoY-- ------------------------------------------------------------------- Phone----P_ai ---------- Installation will serve: Residence JX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [P Number of bedrooms Number of baths [j Lot size__,0_'__lL___i___-- . __..-_____________________ Water Supply: Public system)6 Community system ❑ (Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)4 Hardpan❑ q TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer isavailable within 200 feet.] Septic Tank: Distance from nearest well-----------------Distance from foundation__------!------_-.Material________ ___________________________�________- No. of compartments________.�----_--------Capacity------ d __Size_ �___ !xfr _�CLtquid depth___S_2___-_______-__. Cesspool: Distance from nearest well---_-------------Distance from foundation--------------------Lining maferial__----------______-______-___________ ❑ Size: Diameter-----------------------`--------------Depth---------------------------------------------------- Privy: Distance from nearest well________________________________ _-__-_--Distance from nearest building------------------------------------------ El Distance to nearest lot line__________ ___________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation_______i �`____Distance to nearest lot line___ __ Number of pits--------/-----------Lining material__�"` �[[___ •_-Size: Diameter---��_____________Depth__-__,T_Q---_________________ Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line.__...-_____----- j ❑ Number of lines-----------------------------------Length of each line---.F_------------------------Width of trench--------------------------_____,__-- Type of filter material-------------------------Depth of filter material__--_---------------------- - Remodeling and/or repairing (describe):------ - -- ...... -- ------------------- am ... ...._.._- u--------�'�'-+G'� - ---- - --- -------------• ------------------ ------------------------------- --------------------------------------------------------•-• ------------------------------------------------- -- --------------------------- - -------------------•------------------------------------------------------------ - ------------------------------------------------------------------------------------------- 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)-----.Y ' ! `,` --------------------------------------------------------------------------- or Contractor} } By:. �•�� f ------------------------------- -------(Title}__ .�P - - --------------------- ------ (Plot plans, showing size of lot, location of system in relatiorf to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- DATE---__—6'__�' "_fes` REVIEWED BY------------------------------------- = DATE �`1''-S -- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------- -- f .. ---------- ------- Alterations and/or recommendations:------------------------------------------------ --------- --------------------------------------------- - ----- -:. - ---- ---------------------------------------------- --- IV - -------------------------------------------------------- -------•---------------------------------------------------------------- -�------------ --------------------------------------------------------------- - ------------------------------•-------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------•-----•-------------------- ---------- PERMIT No----------------- ------ ISSUED------------------------------------------(Date) FINAL INSPECTION BY:--- --------- �- -------��'-=----------- Date------------� � s � � �------ )------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California B-9-2M 9-50 W4639