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777777' Z APPLICATION FOR SANITATION PERMIT `V6 Az` (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 Ordinance No. 549. JOB ADDRESS AND L ATION 3 - -------.S' ar .. ------kol-- ----------------------------------------•- X- - Owners Name------------ - -A ------ Phone Address------------------------------------------------------------- ------------------------------------------------=-------------------------------------------------.................................... OAP Contractor's Name Q -- ----- -- ----------------------------------------- Phone-------•-----------------------•-- Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooroc..�'1Vumber of baths [ J Lot size-------------- Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob 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....................................--_-____--_. ❑ No. of compartments--------------------------Capacity---------------- -----Size---/------------r--------•--------Liquid depth------f •CesKSize: Distance from ne t well_rr. ..Distance from foupdation___6_�1___..Lining material...... -d r sDiameter----- ( ► C'3 ------Depth-----------14D--------------------- - '-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-----------------------Size: Diameter--------_---------------Depth._______________----______---_.-_ Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line..... ❑ Number of lines-----------------------------------Length of each line___-_-_--___-___-----_-______.Width of trench-------------------------------- Type of filter material_________________ _ Depth of filter material-----___.-------------- o , Remodeling and/or repairing (describe)-------- - ------- -- - ----------- ---' ------------"Pw--.---------S..6_ r---- . -- ----• ------------------------------- .................................................. ---------------------- -------- --- ----------------------------------•---------------------------------------------------------------------•------------------------- ------- ......................... I herteb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances ae laws, and rules nd regulations of the San Joaquin Local Health District. (Si ned -4�----- 9 ) $ - (Owner end/or Contractor) e------------------------------ plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -- -•- --- ------------------------------------------------------ DATE--------4,41-41 91.............. REVIEWEDBY---------------------------------------------------------------------------------- -----• DATE------------- ------------ ------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE----- ------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------- ---------------------------------------•------------------------------------------- - ----------------- ------------ -------------- --------- � -------- - -- ------ ---------------- -- -- --- ---= t 2� _ I ----------ccc...`----------••--- PERMIT No.....%l......... ISSUED___�-k- .V....................(Date) FINAL INSPECTION BY:---------------- Date- ______-___-_-_Date_ ------------------------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639