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APPLICATION FOR SANITATION PERMIT (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 Ordinae No. 549. - -------------- r ------------------------------•------- - --------p-( --- ------- -------------------- JOB ADDRESS AND LO TION_____°___--1.- 0-- i - ------------- Phone-----n 8�2_G'_--------- Owner s Name---------------- ' Address ---------------------------------------------•--------- ----- = �; • ------- Phone--9--0-01-- - --- _-- Contractor's Name--------�_�_�-r'--- � x_4__5-�+--$�_�A --s---------�f--''P?-�'--e----------- --- � Installation will,serve: Residence Cg Apartment House ❑ Commercial ❑ Trailer Court ❑ •Ma/tel ❑ Other ❑ /6-.---�''-®------------- Number of living units: .m Numberiof bedrooms Number of baths V' 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 ❑`_ 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--------------------Mate riai__________-.____".__________-___________-_--____- I ❑ ---Ca aci Size------------------------- Liquid depth_ ` No. of compartments----- ---------------- Capacity ---- Cesspool: Distance from nearest well------------------Distance from foundation-________^,_,-------Lining material_____-_____-____________ ------ ❑ - f Size: Diameter---------------------------------------Depth----------------------------------------------------- Privy: ----------=--------- ------------- ------------ Privy: Distance from nearest well _---------------------------------------=--------Distance from nearest building___________________-_____-______---__- ❑ Distance to nearest lot line------------------------------------------------- p g ____-__Size: Diem Distance to nearest lot line_________________ Seepage Pit: Distance to nearest well________________g_" _Distance from foundation-------------------- ter..______-_____.________.Depth.._____._____-________-___"____-_ Number of pits----------------------Linin material..-----____-- 0 , Disposal Field: Distance from nearest well_________________Distance from foundation---.' ----------Distance to nearest lot line____-;______ '_ W�dth of trench.---.'---- --------- Number of lines__---------1___!___��__-___._--Length of each line__.- --- - Type of filter material____ ___ - --_Depth of filter material_t�-'!__----�� OiC --- --- t Remodeling and/or repairing (describe):________ __ ---------------------- - Y T.,--�------ IS�7 t ----------------•----------------------•-------------------:---- ------------------------------------------ :--------------------------------------------------------------------- --�- --- ---•---------------------------------------- ---------- - hereby have ap application and work en accordance with San Joaquin oun y f the oaqun Local Health ordinances, lwsa drules ndregulation ' o -� (f �, +v Contractor] ----------------------------- (Signed)---�--- ----- s -- ------i Qn � '�` - �- ' ---Title �5 i h?_ ---------------------- (Piot plans, ing size of lot, locaof stem in relation to wells, buildings, a+c., must be, filed with thi application]. FOR DEPARTMENT USE ONLY R • DATE --------------------- APPLICATION ACCEPTED BY------- ------------ - DATE- � ,. ----------------------------------- - - REVIEWEDBY---------------------------------------------- BUILDING PERMIT ISSUE -------------------------------------------- ------------------------------------------ Alterations and/or recommendations:------------------------------------------------ ----------------- ------------------------------ ---------------------------- ----- - •---------------------------------------- I F'--'--'-"-'---------'------"-----'----•-------------•-----------------------•------------------------------------------'-----------------------•--------------.. ---•----•---------------------------- -- J ----------•---- PERMIT No.__ �__ -_3--------- ISSUED----- PERM FINAL INSPECTION BY----------- ------------------- ---- Date_---------------3- ----C` -------------------------.... o SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639