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"71'f- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) € Application is hereby made to fhe 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--- —L 9-3- �,�r -- ------------------------ Owner's Name----------- -it-l--"--------- + _ _ ------------- ------------- Phone--- 3` =f Address------------------------ ------9- M._11�1t_�-------------------------------------- •----------------------------------------------------------------------------------_------------------ Contractor's Name-------------------I -------- k-I) -A_ _----- - -------------------- Phone--- ------- Installation will serve: Residence Apartment House F] Commercial ❑ Trailer Court ❑ Motel ❑, Other ❑ Number of living units: [Z Number of bedrooms M. Number of baths V Lot size-------7_-_-�-^ ------?�_- ------------- ' Water Supply: Public system;k Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 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_________________Distance from foundation-------------------Material------------------------------------------------- 11 No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth------------------------I- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_______----_-_-_---_____ A ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ n Distance to nearest lot line---_---_-___________________y--_________--_•__ 4/40____.Distancq to nearest lot line__ ___ t Seepage Pit: Distance to nearest well_______.___�'�_Distance from foundation_______p Number of pits____--____________Lining material__' _k_f_t� __Size: Diameter______Zr________.Depth_______a4r_�__ilk _Dis osal Field: Distance from nearest well_________________Distance from foundation________________-__.Distance to nearest lot line___-____ ❑ Number of lines----------------------------------Length of each line-----------------------------.-Width of french----------------------------------- M Type of filter material-------------------------Depth of filter material-_-__________-_________ " Remodeling and/or repairing {describe): ��Xl � _! rE ------i ds- ------- 1--- •_--- -------------------------------------------------------------------------------- --------------- --------------r--------------- ---------- --------------------------------------------------------------------------------- ----•-----------------------------------------------•---------------------------__------------------------------------------------------------------------------------------------------------------------------ -- hereby certify that I havo,prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5tatewla s, at�Sl rules+�and reg 1ations of the San Joaquin Local Health District, s (Signed)�9 ) ---- .---- ----- - - --��-- ---------- --------------------------=-------------------------- - .n. r=ood/or Contractor) By:---------- {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---------------------------------------- ----------------------------------------- DATE---------- - -T- iv 77 - -- ( - REVIEWED BY---------------------------- ---------- - -- DATE BUILDING PERMIT ISSUED--- -------------------------------------------------------------------------------------- ---- DATE---------------------------------------------------- Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------•--------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- € ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------------------•----------- ----------------------------------------------------------------------------------------------------V PERMIT No.-/I-_,T�____,_____ ISSUED______T 3�_-S7�_____--(Date) FINAL INSPECTION BY:_______'�1 � .� .y Date----------------------- �-------�-�------ • SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9—•2M 9-50 W-1639