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is F • k u APPLICATION FOR SANITATION PERMIT y L i (Complete in Duplicate) S Application is hereby made to':the San Joaquin Locaf Health District for a permit to construct and install the work herein described. This application is made in corripliance with County Ordinance No. 549. • u —i JOB ADDRESS AND LOCATION - - (0051 .......... '7C7 i Owner's Name--- I �� -------------------------------------------------------------------------------- Phone------------------------------------ I Address p1 1) ---------------------------------------------------- 42 Contractor's Name _YY_&-4------------- ---------------------------------------------------------------- Phone-------------------------------- Installation will serve: Residence % Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: Number of bedrooms 7 ❑ J� Number of baths ❑ Lot size--------__1_?�___._�/r?�___ ___________________ �.. V Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of!3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cfay Loam ❑ Clay Q Adobe LN' Hardpan O li. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well----- TC?��_-Distance from foundation-----JA__-------Material________' ti _-____________. No. of compartments-----------_Pc--_-_-----Capacity_______ Q---------Size-----16- -5G__�-6- ---Liquid depth-------S ------____-. { Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------------- 0 Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well______________________________________________ ___Distance from•nearest building__________________________________________ ❑ Distance to nearest lot line-------------------------------------------•__-- r Seepage Pit: Distance to nearest well______ _____Disfance from foundation-------_ _ ____.Distance to nearest lot line------1_U_______ Number of pits----------I_ g ______-__Linin material--------- Diameter_______ 3-__________.Depth--------ZD__ -------------- Disposal Field: Distance from nearest Well____1_ ___Distance from foundation`+--------_ _°}__' ___Distance to nearest lot line-' Number of lines____________ 1Length of each line________--_5~ClWidth of trench_______-_i� -_� _ ____-_. Type of filter material_______1_I �h -------- Remodeling and/or repairing (describe) V �VVA - - ;; - --------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 ru es an ulations of the San Joaquin Local Health district: (Signed) '` f �!" - _______________ __________(Owner and/or Contractor) By: --------- = ----------------------------- ----------------------- (Tifle)---- ��T► _f-----------------------. (Plot plan showi siz#'of lot, locat— ion of s ste in relation to wells buildings, etc. must be filed with Y g , h this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE---------------% , REVIEWED BY---------------- � g----------------- ------------- ,� �----------===-- , ------------------------------------------------------------------------ ----------------------------------- DATE--------------- - ------- =----------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE s -------------------------------------------- Alterations and/or recommendations--------------------------------------- -•------•-----------------------------•--•------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- -------------------------------------------------------------------------------•---------------------••--------•--------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ! ------------------•-----------------------------------•---------------------------------------------------------•------------------------------------------------------------------------------------------------------------ PERMIT No------------------------- ISSUED---------------- ---------------- - ------(Qate) FINAL INSPECTION BY:-----�l '/-_1 -��------------- - ---------- Date------------------ ----� --f'� --�'---- ------------------------ I Ip SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street x ES-9-2M 9.54 W=1639 Stockton, California