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r�..�+:��'y -• � `�� APPLICATION FOR SANiTATI ON . PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct an install the work herein described. This application is made in compliance with County Ordinance No. 549.' JOB ADDRESS AND 1 LOCATION_ '._7/4 � �� •---- c Owner's Name. ---•---- Address.. -_-,--5 -------'-3••- ' ------------•--------••----••--•--•--- ------ Phone , _.....�,ontractor s Name.--- r ------------------"--• - - •-------•--------•--•"-------"-------------------•----------- ----- ------ Installation will serve: Residence partment House Phone" ..................... , A ❑ Commercial ElTrailer Court ❑ Motel ❑ Other ❑ Number of living units: 'ED Number of bedrooms a Number of baths � Lot size ........ : U~Q Wafer Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Grave ❑ Sand m[ a � ~~ l Y LoaClay Loam .0 Clay ❑ Adobe ❑ Hardpan ON TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic Tank -or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance -from nearest well- Distance from foundation._.__lV-_•••.-.Material...__.._ " No. of compartments__ 2 ----.....__... Capacity-------�''�d {1 � - Cess Cesspool: Size__ . _t�-�t -"-•.Liquid depth..___- �+�"-c7';' P Distance from nearest well.__.._..._ - ----- E .--_ Distance from foundation...- -.Lining material ........... --_" ❑ Size: Diameter-- ------------------ ---•------.Depth------------------------------------------ ------------ Priv :--•------- •, ,Y Distance from nearest well. .......................... - Distance to nearest lot line. .....................:._-•- ------ .. Distance from nearest buildin Seepage Pit: _ Distance to nearest well--------- ... -..._ -Distance from foundation ----- _t ---------- .Distance to nearest lot r IiNumber of pits ------ - --------------Lining material ....................... ------- - Size: Diameterne........ Dis -r�.......... Depth. �sField: rDistance•-from*nearest-:well ,-- Distance afro . � oundation : �� `" -� Distance, lot line" -- Number of lines ............... . i nt '" ---- Length of / :..,p-...� ' '- Width of trench._..-----o2-E Type of filter material._f'j-�-_."_-_-- •--""•" - "'--•""-'--- - - -� Depth of filter material ........ 67.11' R'emodefi-ng and/or repairing (describe) :..................... ---- ------•----- -------------- ---- ----•- ..... .................................................. -- ---•-....._..._-_.....------------•---------------- ---------------------- -------------------•------------... I hereby certify that I have prepa;ed this application and that the work will be done in accordance ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. with San Joaquin Count (Signed)_... i i (Owner C BY�----•-•'............................. •-•--..._ - .------...._. - (O rand/or Contractor) (Title)._-•-------------•- . (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fried with this application), FOR DEPARTMENT USE ONLY -- APPLICATION ACCEPTED BY_ ----- _-._•"__-_ REYIEWED BY------------------ - DATE--------•--- BUILDING PERMIT ISSUED-- ---------- --- ---- ---•--------- - -- -------- ' ----•------ .....---•---•---•--------....------------ - DATE ----- - --- - Alterations and/or recommendations:, . ...........-"" _ DATE.......----•-------•---.._._... --------------------------------------------------------- ------ ------------_----- ---------- -------------- I .................................... -------------------------------------------------------------------------------------- ......................... ------------ - .... -- ---------- `------------------- - PER-----•-•---•- ---- -- --------•---• -- MIT No..f ISSUED-.-- / �-%S -1 --.------ (Date) FINAL INSPECTION"- .. - Date_-� 1 (A) SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES -9--2M 9.50 W=1639 Stockton, California