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APPLICATION FOR SANITATION PERMIT 6 --� (Complete in Dup[icate] Application is hereby made to the San Joaquin Locaf Health District for a permit to construct and install the work herein described. n Y This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------------------- /�-N=-' t Owner's Name,-----------1%4 cf-/�L�- L S A—) ,4 ------------------- ---- -+ -� --------------------------------- Phone--_------------------------------:-- Address------------------------------------------------------` it/--C------------------------------------------------------------------------- Contractor's Name--------------------------------------------- -— Phone----------------------------------- € Installation will serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: ❑ Number of bedrooms Number of baths Lot size_______ -/ '---.®-------------------•--------- Water Supply: Public system ❑ Community system ❑ Privatex Character of soil to adepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (� Hardpan ❑ w TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is ,ailable within 200 f f.] Septic/Tank- Dist nc fm near st wefl-C_ iilance from foundation--------------------Material ____-___-_____________________________ Q�J o compartmpt s--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- Cesssp`ool: 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------------------------------- ___ Di os Field: Distance from nearest weil__�v--------Distence from foundation---_-/Q________Distance to nearest lot line------S--__ 0`� Number of lines---------------t-----------------Length of each line__________lpd_nGs.`i_�Width of french-------- � ______ r Type of filter material-------------------------Depth of filter material----------------------- L; . e17. _ ld Remodeling and/or repairing (describe):__--_____--�I—Ze(4.......•r»-------7Z-------- ___-__-_--___ ------------------------- -----------------------I---------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------I-------------------------------------------------------------------------•--------------------------------------------------------•---------------------------------------------- -------------------------------------------------------------------------------------.---------------------------------------------------------------------------------------------------------------------------------------- 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 ofthe San Joaquin Local Health District. (Signed) �, n -(��Clf��•t,� `" -� -----------------------------------------------------------------------------------(Owner and/or Contractor) 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--------------------------- --- - ---- ---- -------- ------------ ----------------- DATE-------------- REVIEWED BY----------------- ----- '^-- DATE ----------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------•--- DATE Alterations and/or recommendations---------------------------------------------------------- - ---------------,--------- ----------------------------------------------------------------------------------------- - - ---------- --------- -75- -------------- -----------------------------------------.:__-------------------------------------- k --------------- ---------- PERMIT No.--`-'�--Z ISSUED_ a �/6 - - ---(Date) FINAL INSPECTION BY--------------------------------------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639