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APPLICATION FOR SANITATION PERMIT 1 (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 No. 549. JOB ADDRESS .AND LOCATION_______ � /� - ' '_ Phone_ -------------------------------------------•----------- Owners Name_._-_______�- - -- ------ i U°�l !/�`-------------------------- Address--- �� ' one --------------- Contractor's Name_------5 ----- Apartment House ❑ Commercial ❑ Trader Cour} ❑ Motel ❑ Other [IInstallation will serve: Residence p ; - ------------ Number of living units: ❑ Number of bedrooms Number of baths ❑ Lot size--- _____ i� Water Supply: Public system ❑ Community system ❑ Private Cf' Clay Adobe ❑ Hardpan ❑�p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Y ❑ %S1 TYPE OF INSTALLATION AND SPECIFICATIONS: able within 200 feet) (No septic tank or cesspool permitted if public sewer is avail . - Distance from foundation____I_K--..Material__ _d �--�itw Septic Tank: Distance from nearest well --------------------------------Liquid.depth___________________________ No. of compartments--------- -d2--- CapacstY-/dd_a- Size Cesspool: Distance from nearest well-----------------Distance frorrfoundation___-.___--______.__-Lining material________________-____ ❑ Size Diameter--------------------------------------Dept ---------------------------------------------------- 11 --------------- ---------------- -------- ---- - - ------------------------Distance from nearest buildin ------------------------------------------ Privy: -------------------------- - -- Privy: Distance from nearest well_________________________ - ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------------------------------- to nearest lot line-.--.-----_----- 4 ❑ Number of pits---------------------Lining material-----------------------Size: Diameter__--------__------- - Nsposal Field, Distance from nearest well_----Distance from foundafion___f__� -Dss�ance to nearest lot line.-I-0------ . ------ 4of each line-----/ _ f - Number of line - h PDOp - Ater material------ -------=-- Type of filter material__ _4_G�- I . ` ' Remodeling and/or repairing (describe)______________________________ --------__ 1 -------------------------------------- ---•------------------- -- '----------•------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ealth District. ordinances, State laws, a rules and regulations offhes aquin Loc (Owner and/or r Contractor) (Signed)-- ------------ --------'--------------------------- - --(Title) - _ (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application. I FOR DEPARTMENT USE ONLY DATE-------�. _•`* "- �. �----------------- A -------------- APPLICATION ACCEPTED BY-______-_______- -� - DATE----------------------------------- t REVIEWED BY------------------------ ------ -- -------------- -- ------------------------------------------------- DATE-- ----------------------- - --------------------• --------------------- - --------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- --------------------------- ---------------------- Alterations and/or recommendations:-------------------------------- -__•____-__________________ -----------------------------------•------------------ 1, V. R� -^,i R_1 ------------------------------------------------ - FINAL INSPECTION BY:_______ :____-__-________-D -__._ t PERMIT No. ISSUED ` y � � ate----------------�- --------------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California �, ES-9-2M 9-50 W-1539