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APPLICATION FOR SANITATION 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 Ordinance o. 549 /� , zevl (,3G�JOB ADDRESS AND LO ATION_ =''.'t'1 '- Owner's Name ---� ---- - •- - ---------- ----- .-I-a--------------------- Phone- ------------------- Address------/ -----�- - y�------------------------------------------------------------------------------------------------------- Contractor's Name...... ?Air -- Phone`____, Installation will serve: Residence { Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: [ Number of bedrooms;2 Number of baths 0 Lot size_ _______ ------------------- Water Supply: Public systemCommunity system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand [j Gravel [I Sandy Loam El Clay Loam ❑ Clay ❑ Adobe)( Hardpan E] 04�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well------- -----Distance from foundation...... _______.Material_____ is No. of compartments-----------�.-------Capacity---___-�A a---Size_--_rF__^_14-Araiquid depth__-.Z-------------- Cesspool: Distance from nearest well---------_-------Distance from foundation--------------------Lining material__---____________________-----______. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F _______ _-----------------_.❑ Distance to nearest lot line------------------------------------------------ r Seepage Pit: Distance to nearest well_____!!�------Distance from��fSS,,�u�ndation_____ 0_�.___.Distance o nearest lot line--/-*_-____- Number of pits-______/__---_____Lining material_r.�______�h-___Size: Diamreter._. -_______.Depth___.__ ____________�__ Disposal Field: Distance from nearest well_�-------Distance from foundation_______ ___Distance.to nearest lot line----- - Number of lines____________ __ ��__.___ Length of each line_____ �_A --- _��___.Width of trench__-_'-Z -----=--=-------- Type of filter material__.j, Depth of filter material--___1_ '_________ 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 regulations of the San Joaquin Local Health District. __ I/or Contractor (Signed)---- lX4&4� "� - { ---- ------------ ---------------------------------------------- (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--------------- -,' 3----------------------------------------------------- DATE---------0------------f- _ l - REVIEWEDBY---------------------------------------------------------------------------------------------------------- DATE---- �' ." '�/---------- 1 BUILDING PERMIT ISSUED--------------_-------- ----------------------------------------------------------------------------- DATE--------- -------------------------------------------------- Alterationsand/or recommendations----------------------------------------------------------------------------------------------------------•---------------------------------------------------- -------------•---------------------•------------------------------------------------------------------------------------.------------------.----------------------- -------------------------------------------------•----------------------------------------------------------------,--------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------- PERMIT No.--,)S ------------- ISSUED----/-/7- _-- ----------------{Date) FINAL INSPECTION BY:---:-- '-_i± - - -�'---------------------------- / -t-- i I �� Date----------------------------'---------------- ------------------• - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639