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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) mak. Application is hereby made to the San Joaquin.Local Health District fora permit to construct and install the work herein des=ribed. This application is made in compliance with County Ordinance No. 549. . JOB ADDRESS AND LOCATZN----5--OZ-3-------- '"' .----- -------------------------------------------------------------------------- Owner's Name------�-_ i------- - Phone M Address-.-----3-1-3------- 4 \j Contractor's Name 0�_ o � - ------ ------------------------------ Phone---/ -----7- l Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ } Number of living units: .Z Number of bedrooms 2 Number of baths Lot -------------------------- Water ____-___________Water Supply: Public system 0 Community system ❑ :Private Character of soil to a depth of 3 feet: . Sand E] Gravel ❑ Sandy Loam ❑ Clay Lbam ❑ 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 depfh--------------------------- -Cesspool; Distance frdm nearest well-----------------Distance from foundation_.=-----.------.----Lining material----------,___________-_____________- ❑ Size: [Diameter--------------------------------------Depth----------------------------------------------------- Priv Distance from nearest well---------- ---------------------------------------_ Distance from nearest buildin Y' g------------ ❑ Distance to nearest lot line-----------------------------------__--___----- Seepage Pit: Distance to .nearest well----------------------Distance from foundation---------------------Distance to nearest lot Iine----------------- F1 Number of pits---------- ---------Lining material-,---------------------Size. Diameter-----------------------.Depth :_-----------------__-------- 1 .Disposal Field: Distance from nearest well____ from foundation------ ----------Distance to nearest lot line__.__7-.______ Number of lines___________ 1_�_._��___ - Length of each line------��-l___��--Width of french------,,2_X{--- ------------- Type of filter material-_��____/7-j__Depth of filter material------- R-_______ S Remodelingand/or repairing (describe) -----------------------------------------------------------------------------------------------•------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- -------i ( /or Contractor) s -------------------------------------- -- 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_, / = j--= --- - ------------------------------------- DATE-------=r"� -- ----ar• REVIEWED BY------------------------------------------ ------/ --------'�--_ ----------------------------------------- DATE------------------ f BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------:------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ -------�---- -------- � ----------------- f ------------------------------------- ------------------------------------------------------------------- ISSUED--- 3 - -------- Date FINAL INSPECTION 'BY; PERMIT N BY:_- ,r �j �Z`r��YJ Date. %/�1_ `•SV �y ---•---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639