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APPLICATION FOR SANITATION PERMIT ; (Complete in Duplicate) I 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 CATION---- --- xl- --------- ----- � _/-�------ --------------------------i+ ��-------- ---------------7 --------- Owner s Name____________; ,r Address----------------------- Z---------� � -------------------------------------------------------- ---------- - Contractor's Name-•----------Da ------ ----------- Phone-/--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Eq Other ❑ r. Number of living units: Number of bedrooms �& Number of baths 0.- 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 ❑ Adobe ❑ Hardpan ❑ kt,__ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A _ Septic Tank: Distance from nearest well-----------------Distance from foundation_---.------------.-.Material._____________________________________________- ❑ No. of compartments------------- _---_Ca acity__-_--_- -S:�-Size-------------------~ " ------Liquid depth----------------_-------- Cesspool: Distance from nearest well-----------------Distance from.�faundation________________---Lining material-__________.__- �_-- ❑ ize:-Diame+er-_______—�--------------------—De th '"" ","" — Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___ ._ ________________ ' --�� - --- y-. _ _. ..Y .- �. _.J r.n-.... r T ---- -- . Seepage Pit: Distance to nearest well_____ Distance from fou} f -- j ❑ distance to nearest lot line_____________________________ __________ _ _____________ ndation__ � .rt~______Dista Distance to nearest lot Fe 'r __-__._ Number of its_e-2&zt._________Lining materia 4,#_ ,6JQ Size: Diameter___ = p• L- g '� �-- �-- '��-----------.Depth_-_� ----------------------- Disposal Field: Distance from nearest well_)V4-___--_-__Distance from foundation__.G______________Distance to nearest lot Ike___________:____ �JNumber of lines__ __-OjY,?---------------Length of each.line___ r__ ______ Width of trench___ - _____________ -__. 1 ,� Type of filter material__ -ek<---______Depth of filter ff Remodeling and/or.repairing. (describe):------------- 19_// --------•--- -------- ---------•- --------- f. ------------------- F -------------------------------------------------- =- '---------- ------------------------'----------'------------ ---------'---`- ---------------- ---------------------------- ----------------------------------------------- -----r ------------_"------- �• I hereby certify that I have prepared this application and that theyork will be done in accordance.with San Joaquin County ordinances, Sta� .laws, and rules and ulations.I the San Joaquin Local,Health District. i '__l _'8''C �t--- -- ------- ------------ r _ Owner a or C ntractor * , (Signed)-----------r f f---- f --- - y -� / SF� -Q -�[.- / --------- -(Title)_- t Y:----------- : -------- ----- l,� _ (Plot plans, showing size of lot, location of system in relati n to wells, buildings, etc., must be filed th.this application). f FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY_____________ - y}` �-'_----�� - - � - - DATE-------------- --�-.----�---�----'��---�----------- - REVIE - - REVIEWED BY "' DATE --------------- -----------`------------------- -�'-'•- - BUILDINGPERMIT ISSUED--------------------------------------------------------------rrr-, >'--------------------- DATE------------------------------------------------------------- Alterations and/or recommendations______________________ _____________,_____=i_ `------------------------ ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- l --------------------------------------------------------------------------- ------------------------ -•--------------------------------------------------------------------------------------------------------------------- ---------------------------•---------------------- ----------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- - - --- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------- -- - - ---- 11 l PERMIT No__7!_ 1--------- ISSUED } ----•----_---(Date) FINAL INSPECTION _BY:--- ` Date------ - i t 'Fy- �'� -SAN JOAQUIN-LOCAL H�ALTH.`DISTRICT- -130 South American Street Stockton, California ES-9-2M 9-50 W-1639