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�S>� APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) E Application ':s 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 -----jS_�.j------- R G�t� ' ------------------------------------------------- - ----------- ----- Owner's Name-----5-.--_ `----- i --------------------------------------------------------------------- Phone-1 r--- ------------------ Address---- ----------- Address---- •-00�------- Contractor's Name---.T)A-:!---i le 1 �1- '�--- --a... _---- ------------------------------------------------------------ Phone-_0" _11f `7------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ : Number of living units: 11 Number of bedrooms Number of baths Lot size--- ________________________•--- Water Supply: Public system 39 Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobel5t 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 wofl-----------------Distance from foundation---.---------------.Material------------------------------------------------- El ______-__ __________________-_-______________- ❑ No. of compartments-----=--------------------Capa`ity-----------------------Size------------------------------Liquid depth-------------------------- t. Cesspool: Distance from nearest well_________________Distance from foundation--------__-------- .Lining material___-________________________-_•-____-. ❑ Size: Diameter--------------------------------------Depth------------------------I------ ---- ----------- :. t Privy: Distance from nearest well------------------------------ _________________Distance from nearest building------------------------------------------ t ❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from-foundation___.r_ Distance to nearest lot line----!'l_______ Number off_"_____.._Lining material___-__lW.Size: Diameter____ _____._� ___.De th_____/' �j Disposal Field: I Distance from nearest well_________________Distance from foundation_--__________________Distance to nearest lot line___-______--__-- ❑ Number of lines-----------------------------------Length of each line-----------f__________--__---Width of trench----------------------------------- Type of filter material--------------------------Depth of filter,•material----I____________.___ "Remodeling,and/or repairing (describe):-----4_4414W----- ---•-----------------------=-'--:---- ----------------------------------- ti If i ---------------------------------------------------------•---- "''# { ----------- --------------- -------- ---- F 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, a d rules and'-re ulations of the San Joaquin Local Health District. A (Signed ' F .. - - --------------------------------------------------------------- (Owner and/or Contractor) Sy:----- z (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----- REVIEWED BY-----------•------------------------- -��'--- _--------------- -------------------------------------------- DATE--------------- BUILDING PERMIT ISSUED--------------- -------------------------------------------------------------------------------- DATE--------------------------- Alterations and/or recommendations:----------------------------------------------------------------------------- ------------------------------------------ ----- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------•-----------------------.-----------------------------------.-------------------------------------------------.•------•--------------------------------------- ! ---------------•---•-------------------------------------- ------------•..---•---------------------------------------------------------------------•------------------------------------- ----------------------- - PERMIT No. 0' e >-. J� _ ----- ISSUED------- ----------------r---------------Date) FINAL INSPECTION BY: -L�r� ,�/ Date------------ SAN JOAQUIN LOCAL HEALTH DISTRICT I a 130 South American Street Stockton, California ES-9-2M 4-5Q W-1634