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�Zo z.- APPLICATION FOR SANITATION PERMIT a (Complete in Duplicate) a� Q � Application is hereby made to the San Joaquin Local Health District for a permit to constrg�yyt and install the work herein described. This application is made in compliance with County Ordinance No. 549. p�F '?9 01- W4 JOB ADDRESS AND LOCATION-•---- ' -- �L ��.. '= Owner's Name LO �Q-CF' --------------------- - - - ----------•------------------------ Phone------------------------•------- Address � fi Contractor's Name. o 4— ' /� � ��- _ Installation will serve: Residence eApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - Number of living units: i Number of bedrooms L -.Number, of baths I6 Lot size---- ........----------- Water .........Water Supply: Public system Community system ❑ Private ❑ _ Character of soil to a depth of 3 feet: Sand E] Gravel E] 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.................Distance from foundation--------------------Material.................... ._._ ...._.__...____ ❑ No. of compartments..........................Capacity-----------------------Size-------------------------------Liquid depth.............. Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material-------------........................ - ❑ Size: Diameter------------------------ -•---.....__Depth--------------------------- --------------------- Privy: Distance from nearest well---------------------------------------_---------Distance from nearest building__________________•----_-__-____---- 171 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 _--__-__---_____--._ _. --Type of filter material___________________---Depth of filter material........................ Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------- ---------------------------�Z -�,.�:6----_-------�..: - ... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , and rules d r ulations of the San Joaquin Local Health District. � � ��(Signed)-----L--�------ �--------- -- ------------------------------------------------------------•=----------------------. (11111111111111116nd/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 BY --- -- DATE------- REVIEWED BY t ''-- --- ------- - -- -- - -- -------------------- ------- ---- --- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------•---------------------- ... DATE------------------------------------------------------------ Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- ----- ---- - - - ----- ---- --................... .................................................................................................................................................................................•._......._............._.._...._..__..__.... ---------------•_---_-_...�j........'.._..___..._.__...._-_.._.__....-___....____.__.._...__........................................................................................................................................ PERMIT No..�v.A------- ISSUED----. -----------(Date) FINAL INSPECTION BY:. "'t ..------.._----•---- Date----.- fj 1)_.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639