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APPLICATION FOR SANITATION PERMIT 7 (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 No. 549, JOB ADDRESS AND LOCATION_ -_ Z av".�- Owner's Name-------- Address------------ ------ Phone---------------------- --------•--- ontractor's Name------••-------------- _At" ---------- ----- ---- -----------------------•--- -----------------" ---------------------- - --- ----------- = Phone �T 7 `- Installation will serve: Residence JA Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: 'M Number of bedrooms .21 Number of baths ❑ Lot size-----------•fid".>e__,( c C)__ Water Supply: Public system C' Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ . Clay ❑ Adobe IK Hardpan ❑ ! TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_ --_Distance from foundation-------lQ-_` Material. ___"& J _ No. of compartments_____-_--"- -"_ -____------Capacity-- •- © b-------------- Size-------��!1X*rLiquid depth ----� ,Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- Lining material_______"____ ------+�--�------ Size: Diameter--------------------------------------Depth_-------- ---------------- - ----------------------- "Privy: Distance from nearest well__________________________"_ __ Distance from nearest building-_______-_""_"" -"_ ❑ Distance to nearest lot line__ -------------------- Seepage ------------------- Pit: Distance to nearest well______________________Distance from foundation-------------------- ElNumber of pits----------------------Lining material----------------------- Distance to nearest lot line__-____--__-_____ ' Size: Diameter------------------------Depth------------------------------ Disposal Field: Distance from nearest well____-�------Distance from foundation___ Q_-_"""--.Distance to nearest lot line____�l_�_�__ TypeNumber of lines-------------��_�____"____""-----Length of each line--------- Width of trench---------y'xy"_--___ Type of filter materiaL_f?�_'-2"--•--_ Depth of filter material---____1 !'_-_""" •---------------- `" Remodeling and/or repairing (describe)________________________/U + N-I--- _ -------------- ---- -----------------------• i -------------------------------- ------------------- -------------------------- a hereby certify that I have preparegd }his application and that the work will be done in accordance with San Joa uin County ordinances, State laws and 'rules and re ulations of the San Joaquin Local Health District, q � -- - - - --- (Signed)-- BY ---------"""--"-- (Owner and/or Contractor) (Title)------------- [Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). k FORbEPARTMENT USE ONLY }�- - REVIEWED BY------------- ------- ---- ------- ----=-- ------- - ---------d�,________ -_------ ------- --------- ------- -- DATE ----------- ---�-JV_ 7� ------- ---- PLICATION ACCEPTED BY_____________r_____ - BUILDING PERMIT ISSUED-------------------- --------- DATE -------------- ATE----------------------------- ------------- ------------------------- era ions and/or recommendations______________ --------------________.__ -------------------- --------------------------- --------------------------------------------------------- ---------------------- ---•--------------------------------------- - ------ --- ------------------- NOV --- PERMIT _ _"" ISSUED // _-"_"_-- -•-"""_- ---------- ---. ----(Date) FINAL INSPECTION BY------------ -- - -- ------------------ Date ----- -----------Date -- ----------- - - �--- ---•----- SAN JOAQUIN LOCAL HEALTH DISTRICT -- - -- 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California