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✓h APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Appli ation 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 Ordi, nce No. 549. JOB ADDRESS AND LOCATIN� � 40---- -- ----------------------------------------------------------------------------------------------------------------------- Vt Owner's Name-- ------ --- -----------------L -- ----- ---- --------------- Phone-----r---------------------- Address----------- _ M ----------------------------------------------------------------------------------------- Contractor's Name- -------- ------- -------------------------- --------------------------------_------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ }Mote) [I Other Ej Number of living units: Et Number of bedrooms ISL Number kbaths Et Lot size---Ilt__ ____�_.f'Sf_L9 _"( � • Water Supply: Public system E] Community system ❑ Private I Character of soil to a depth of 3 fee+. Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay E] 'Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if//��ublic ewer is available within 200 feet L Septi ank: Distance from nearest welll;'A►_�Distance fro fou dation---- --------- ataid I_-�_ No. of compartments___________ ______-_-Capacity____ __�____Size_�__� -----------Liquid depth---------- ------ - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_________________,___________-____. o ` ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- N Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________________________-_____________ O ❑ Distance to nearest lot line________________________________________________ [ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_________________ ❑ Number of pits-------------------//ff-Lining material-----------------------Size: Diameter-----------------------.Depth------------------•--------i_--- Dispos Field: Distance from nearest weIU3�Distance from foundation__'' _ -7.----Distance to nearest lot li e.�.-`-`- ------ Number of lines----------r�___�� ___ .-Length of each line---------�_� _-__.___-Width of trench______�___� ______________ Type of filter materidlA_�, ' ? ,Depth of filter material______ _ .__. IF LT 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' reg`lations offhe San Joaquin Local Health District. (Signed)__________________ _ ______ � __ __ ___(Owner and/or Contractor) By:---------------------------------------------------------- -- ---- -------------------------------------------------(Title)---------------------------------------------------------------. (Plot plans, showing size of lot, location of Sys t m n relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-4?--------------------------------------------------- ---------------------------------------- DATE r ttb REVIEWED BY---------------- - DATE----�-------------------------------------------------- --------------------------------------------------------------------------------- BUILDING PERMIT ISSUED------------ DATE-------- ---------------------------------------------- Alterations and/or recommend a+ions_------------__ _ _ --- --- ----- - - ------ --------- S --------------------------------------------------------------- --,------------------Z------ ------ ----- - ------------------- ----------- rte... = ---f--------- ---k."A ----------- - ----- ------ ----------------------- ----------fit.. ----------1-1�-� _-=�--- --------------------------------------------------------------------------------- ------------------------------- PERMIT No------------------------- ISSUED------------------------------------------(Date) FINAL INSPECTION BY:-------•-------------------------------------------------------- Date-------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT +' 130 South American Street Stockton, California ES-9-2M 9-50 W-1639