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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 install the work herein described. This application is made in compliance with County Qrdina 6 No. 549: ��yy JOB ADDRESS A ID LOCATION__ ------ ___/'+!--- --- Owner's Name - ----- ------- Phone c�� ---- ------------------------------------------------------------------------------ ------------------------- Address -7`� , ---------- ---------------------------------------------------------------------- ------------------------------ Contractor's Name______ ___ Phone_ _ __ _- .._. ----------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ M tel ❑ Other Number of living units: umber of bedrooms E Number of baths [ZLot sizes:S_;_ �Q - -------------------------- Water Supply: Public system Community system ❑ private ❑ m 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___•y____.___..-Distance fr foundation____ _____________M _ _ --rial.__ _ -----/I --------------- No. of compartments_--------74----------Capacity---2N90---------Size__ -----Liquid depth__ ________________ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------- I ❑ Size: Diameter-------------------------------------Depth------------------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ r Distance to nearest lot line___________________ Seepage Pit: Distance.to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line________________ ❑ Number of pits----------------------Lining material-------------•---------Size: Diamet r-----------------------.Depth-------------------------- ---- p Dis_osal Field: Distance from,nearest well________________Distance from. foundation_j__v'/,_"'___Disfance--- to nearest of line___�r_______- ,� �., .--_-.._._�.---t_ tom_.:.....- _Number of-lines_____________ _______ Length`of each line ___ A_` `• I { Width of trench-, -'- --- -------- -� e. Type of filter materiel _____✓�.+ pepth of filter material__________L_________ Remodeling and/or repairing (describe):----------------------------------------------------------------------------------- --------- -------------------------------------------------------------------------------------- --------------------------------------------------------------•--------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a law , and rules and reg� ions of the San Joaquin Local Health District. (Signed)-- --------------------------------------------------------------------------------------------------------- ---------------- -------------(Owner and/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 B -_ - --�"°,' "---- ---------------------------------------- DATE--------- -- REVIEWED BY---------- --------------------- -- ------------------------------------------------------------------• DATE---- - -- Q BUILDINGPERMIT ISSUED-------------------------------------------------------------- ---------------- ---------------------- DATE. - - -----------Alterations and/or recommendations___________________ ___ __________________________________ ----------------------------------------------------------•---------------g-----G- ---------/----------••---------- ---------------------------------•---•-------- PERMIT No.--- / �`- __ -- ISSUED____�':A --_-.S J _ ' -______.(Date) FINAL INSPECTION BY __------ -- -----__-----__ Date---------------- a SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W=1639