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N, ' 9 APPLICATION FOR SANITATION PERMIT 4 (Complete in Du licate ?/ P P ) , 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 Ordipance No. 549. JOB ADDRESS AND L C TION------- � ---------- ---------�l�.l��-�_/----------- }�--L-�----------------------- ------------- ----------------------------- /��j ,� n Owners Name------------- �------------------ 1. p �n�/ j f Phone P7_J�_ Address - r 4 ? -/{1� /-/--/� ------------- ��- � ��------------------------ ------�4 - Contractor's Name..' ---`----------{ _---'--R i 6--L-y------ � Q 1�� 1��f_ Phone___f -- ---------- -- _ -s� = ` Installation will serve: sidence K Apartment House. Comme�c-0,n Trailer Court ❑ Motel ❑ Other ❑ Number of-livirg units.-El- Number-of-be&ooms r Nurriber of'baths V] Lot-size------f_ f Water Supply: Public system ❑ ,Commuriity_,system .❑ Private X Character of soil to a depth of 3 feet: Sand Gravel Sand Loam P ❑ ❑ y '� ��l.nam� Clay_❑_"Adobe Hardpan ❑ TYPE OF.INSTALLATION AND,SPECIFICATIONS: _ - = ;(No septic tank or cesspool permitted if public sewer is availablewithin`200 feet.) ' Septic,Tan : Distance from nearest well-----------------Distance from foundation----------------------Material_'''_.__-------_-_-----_-; - ------------------------ ❑ ` No. of compartments-------------------==----Capacity-----------------------Size--------------- '---------------Liquid depth---,----------------------- �Cesspdol: epth__'---------------- �Cesspdol: Distance from-nearest well-----------------Distance from foundation---------------------Lining material----__-_-----_-__-_---_-- Tf .❑_' Size: Diameter-=------------------------------------Depth----------------------------------------------------- ,. F Privy,.r:• I y Distance from nearest well__ -- _`--------------=-----------=- =-=-Distance from neatest b�iilcJin *ti-- , El k A 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-------------- Diameter------------------------Depth-----__-----_---_____--_-__------ Disposal Field: Distance from nearest well_-Z---___-----Distance from foundation___ ____- Distance tb nearest -?�_--_--- II1 vTr,],y�.l - - -- fffff -- -- / F f _ � . Number of lines-_-------t____G:'�-----------Length:of each line--- ------------- ---�=:Wid#h of-trench =��--f�------------- •. Type of filter material-__- -_kA__-__Depth of filter material----/A--�--._--_ Remodeling and/or repairing (describe4Q_!Tf G/il-------------- --- ---• � Gt',r�_�i ------------------- ---------------- ---------- _ r- -- I ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ .I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta{e laws, and rules and regu tions of the San Joaquin Local Health District. (signed)ne �9 } -=— + ------ -------- --- _ 'ham Tit-------- _-- .� �. -. �� -- � - ---(- and/or: Contractor) , B ---------------� ' �---------- �' --'� f�i(_�� t_ ] (Owner / By: V ( J P of plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fil4with this application}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------- - - --- --------------------------------- `DATE------------- ----- ------------ ------- - --------------------------------------- DATE------------------- -�''--- --- --- -------------- REVIEWED - ---- - REVIEWED BY BUILDING PERMIT ISSUED---------------------------------------------------------------- ------------------ DATE-------------- ------------------------------------------- Alterations and/or recommendations------------------------------------------------------------ -------------------------------------------- -------------------------------------------------•--------------•------------------------------------ - --------- --------------------------------------------------------------------------------------------------------------------------------------- ----------------- -------------------------------------------------------------- ---------•-•---------------------•---------------------------------------------------------------- - -`------------------------ PERMIT No.__�_ --- .----- ISSUED------- .-/V- --- -- ----(Date) FINAL INSPECTION BY:----- --- __-__ z-- Date----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street E5-9-2M 4-50 W-1539 Stockton, California