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APPLICATION FOR SANITATION PERMIT �h ¶ (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health D' rict for a permit to construct and install the work herein described. This application is made.in compliance with County Ordinanc 0. 549 JOB ADDRESS AND LOCATION-------------- �}-�L_ -_---- -_---- ----- - --------------------------------------------------- Owner's Name------------------------------------------------/_/j9.,ej �---- - -�Sf�EF Phone1�� av Address �J "�S^ , f ./ Contractor's Name------- -------------------- ±!-17 aI¢ �s .r- _ T- --------------------- Phone--- = e�------ Installation will serve: Residence X, [Apartment House ❑ Commercial ❑ Trailer Court ❑// Motel ❑ Other ❑ Number of living units: �fl Number of bedrooms T!f"'Number of baths U A 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 pu is sewer is available within 200 feet,) Septic Tank: Distance'from nearest well -_Q---__---Distance fr m foundation----------__Material--_ . No. of compartments--------------1 ---Capacity_A-�-_ __-------___SiZ'/*��,lL"�e `�l! Liquid depth-- e ' _----- 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---------- ---�_--------- � .—Disposal-Field.: - distance from-nearest well____=-_.Distance from foundation-- ---------------Qistance to nearest lot line__-- -- --------- Number of lines-------/--------- `-- - 1 _Length of each line-__1�J77y---- ---Width of trench__------------ --_ Type of filter materi _7i Depth of filter material-------_--- --- Remodeling and/or repairing (describe):___---_ __- ------------ ----- ------ ---- --)--------- ---- - --------- ----------- ------ ----- - ---- ----------------- ---- ---------------------------------------------- --- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have p epared this applicat' that the work will a done in accordance with San Joaquin County ordinanc r to la , and nd regulations of t San/Joaquin ealth District. (Signed) �+ ______; F 9 } + ]li ' --- --- --------ate fl - -------------------------------- --( Contractor} --- B ------- �- ----------------------------------------------------(Title} , •mss"l/�itff d. �------------------ (Plot plans, show�3e of lot, location of syste inn elation to wells, buildings, efc., must be filed with this application). FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY---------------- A--- ------------------------ --------------:----------------- DATE-------/ - �f------------ DBY -------------------------- ------------- DATE -- -- -------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------------------- - - ---------------- DATE ------------------------------------ Alterations and/or recommendations----------------------- ------ --------------------------------------------------------------------------------- ------------- - -- ----- -io/ -------------------------------------------------------------------------------------------- ----- -- ------- 'L ui►�s.---------!",w A A--------.7—err-------------- -e� ---------- -- ------------- f - -------------------------------------------------------------------------------------------------------------------------------------- PERMIT Nq�t�--a.--7------ ISSUED--------- ---- -/-_J- ------------_-_--(Date} FINAL INSPECTION BY:-----------------� Date--------------- r � y SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street E$-9-2M 9-50 W=1639 Stockton, California