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APPLICATION FOR SANITATION �J 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 OOr�rdina'nc No. 549_ JOB ADDRESS AND LOCATION______-- Address �do•H, --�- --- - - - ------------------ Phone_ /__ pper� Q_----- Owner's Name ------------------------------------------------------------------------------- - f s-_ ----------•---------------------•-------------- � --------------------------------------------------------------------------- Contractor's Name------------------------- -�/_7�__�f}.�hc�S ----¢--��17-�-- 1 "T 11` ------ Phone 9 ©,z--------- Jnstallation will serve: Residence` Apartment House, Commercial `� ❑ Trailer Court R Motel ❑ Other ❑ Number of living units: ® Number of bedrooms ❑ Number of baths �Lot size +_©_` 1C_f/D_-__------ / ----------------- Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑�i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5ja ptic T,wk: Distance from nearest well_________________Distance from foundation_________________Material___________-__.___________________ No. of compartments--------------------------Capacity- -------------- - ---------- ----5ize_----------------------------.Liquid depth-------------------------- -Cesspool: Distance from nearest well_________________ Distance from foundation--------------------Lining materia!_______________________ ___------- Size: Diameter--------------------------------------Depth-------- ---------- ------ ------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest !ot lin - - -- -Seepage Pit:Pit: Distance to nearest well _ 1T�- ___ Distance fro foundation_ - .��_----____--Dist�nce to nearest lot line____________ Number of pits___________ _______Lining material -- �� ____Size: Diameter____T___d ____ -------Depth----f-�------ - -------- ispos field: Distance from nearest well________________:Distance from foundation=_----__-`Disfance to nearest !ot ofrte= Number of lines-----------------------------------Length of each line----------- - a Type of filter materiai-------------------------Depth of filter material___________________ -_ �'�7 Width of trench_________________._ -Remodeling and/or repairing (describe):___` ----------- e------------------- ----------------- -�� . -- -- ---- cz ------ ', ,ct,� ,- ------ ------------- ------------------------------------------------------- __ ------------------------------------------ --------------------------:------------------- -- I hereby certify t e prepared thivaFfil-caflon and that the work will be done in accordance with San Joaquin County ordinances, S t S. and ru �s and regulatio the San Joa uuiin�Local Health District. (Signed)---- L1 _ `----- C•------- -------r "-----n-- - ( Contractor) - - --------- ---- ------- -------------------------------------(Title)---x7,Mj,,0W_f "0 (Plof plans, s owin ize of lot, location of syste in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__________-1a -------- -------40 DATE REVIEWED BY------------------------------- 100 DATE- BUILDING ----- --- - ------------ ---------- --------- --- �� DATE BUILDING PERMIT ISSUED __ rr_-d . ---;$i ►�_,� a `" ------------- -------- --------------------------------------- DATE---�---------------- .------------terations and/or recommendations: -------------------------- ---------------- ,f - - --- ---- - --------------------------- -------- ------------------------------ - ---------------------- ---- -- - PERMIT No._. --- ISSUED_____fL_-_/S_ .3"-I__-(Date) FINAL INSPECTION BY______________ _ -- ------------------------------------- Date------------------r -{ / SAN JOAQUIN LOCAL HEALTH DISTRICT [� 130 South American Street Stockton, California ES--9-2M 4-50 W-1639