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d ua ? APPLICATION FOR SANITATION PERMIT d (Complete in Duplicate) Application is hereby made to the San eJacluin Local Ith District fora permit to construct and install the work herein described. Thisapplication is made in complianc® �?bly� ance No. 549. _. / LL l/ y JOBADDRESS AND LO O T---�• ----•-- ------- -- ------------------------------------..................-------- Owner's Name------------------ -1 ----------/'1/ ---------------------------------------- Phone---------------------------------- ------------------------------- Contractor's Name----------------------- ----- Phone Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ MotelyOther E]too Number of living units: lumber of bedroomsdNumber of bat of size----- __ �fQ-------------•-- WSupply: Public system ❑ Community system E] Private Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam El Clay E] AdobeQ„J:ie�dpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public gewer is available within 200 feet. Septi Tank: Distance from nearest well----V_------Distance fromoundation_--__d----------.Material-------S.i-17---------- ►---- ---------------- No. of compartments----------- ___Capacity...1__ ____Size_ 4_)(__�X•* quid depth------ _______________. Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material_____________-__________----_--______. ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- Privy: Distance from nearest well_____________________________________ __________Distance from nearest building------ _____,________._______.__-.. ❑ --Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material------_------_------- Diameter_______________________-Depth______-______________________- Disposal Field: DistAnes-`from nearest_uell __.Distance from foundations-. -• i ance o e res Number of lines______,____ __ __Length of each line____ ___ --Width of trench______ _______________ Type of filter material.-..P� __&epth of filter material----- �- c C Remo eling and/or repairing (describe):________ _-______ _____ ________ ------------' ------ ��''�+� -•---- -------------------------------------- --- �k....-•--- -- -------------------------- -------------- -------------------------- - -------------------- ----------------------------------------- -------------- --------------------------------------- ----- - - 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, and rules and r ulations oft / an J in Local Health District. Si ned s o?;_;?<. ---------------------(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 a lication). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------ -- ---------- ----------------------------------------------------------------- DATE--------------7 l ---- .... ......... REVIEWEDBY------------------------------------------------------------------------------------------------------ DATE------------------------------------------------ -----_-- BUILDINGPERMIT ISSUED------------------------------------ ------- --- ----- -- -- ------ - ---------- ATE- ---- ----- ------------ ----- •- AlteratioX /or recommendations --------- �d':�'t-.�;/- "!. ^�` --------------------------- -� - - ------------ Olt, I • . I ----- --------------------- ----- ------------------------------------------------------------------------------- ----------- P-----•-------------- f--� ---:-_---------------------_-------------------__-•------•---.--•-_----------------•---------------- ______________ ____________________________________________�Xl_'S_7----_ --------------- _ __ - ____ ____________________-________-__________________'___•___�__ _-__�__~__________________-_________________ PERMIT N ppP-6--------- ISSUED----- _ ___(Date) FINAL INSPECTION BY:___,.� ------------------•--- Date------------ 0 ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639