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I APPLICATION FOR SANITATION PERMIT V1 O (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 NV14JOB ADDRESS AND LOC N------------ /___�. `—- -- 157- �'-Y---04- ------------------- Owner's Name_-• ---- --- ---- �n -------- - Phone -----------�----------------�--- Address------ 2! ---- -------- Contractor's Name----------- -- - ------------ Phone-----�----• ------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ da` � . Number of living units: Number of bedrooms Number of baths Lot size----_- �Z-)_______________ Water Supply: Public system, Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam x P ❑ ❑ Y ❑ y ❑ Clay [] Adoba-�, 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�_��Sf _ -----------Liquid depth___---- -' I' 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-----_-----------------Size: Diameter-----------------------Depth-------"-f------_---------- Disposa Field: Distance from nearest well___`r"-Distance from.foundation___2_��_._1__--Distance,to nearest lot lin _____ ------ Number of lines______________� _______ -� " ___ __� Length of each line___._��___�r__ _ Width of trench___________ ____________________ Type of filter material ____Depth of filter material_______/- ___-.:___ Remodeling and/or repairing (describe):____-___ -tet__ ------------/_1141- ---------.�_-_ /� ` v ------------------------------------------------------•-----------------------------------•------------------ ------�-------------------- y e --------------------------------------------------------------------------------------------------- 1 hereby certify that 1 have prepared this application and that the work will-be done in accordance with San Joaquin County. x S'ordinances.ed Sta#laws and e� d' regulations of the San Joaquin Local Health District. ( 9 ) - .�-y- - ---------------------------------------------------- ----(Owner and/or Contractor) ` BY: Y �� {/: ------------(Title) - k:. (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). f� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- -j - ---------------- DATE------- —100-� 1-1�� r----/------------ REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-------- -------•--------------- �'BUILDING PERMIT-ISSUED----------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:---------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- •--••----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ------- ------- -- PERMIT No._, �I --------- ISSUED-------- ---- -------_`_f--(Date) FINAL INSPECTION BY:-----iN -_.---------------------------- ------------------------- Date-----------------A6 SAN JOAQUIN LOCAL HEALTH DISTRICT f 130 South American Street I I Stockton, California ES--•9--2M 9-50 W=1639 e:. f