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v 3 { � 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 No. 549. q ; JOB ADDRESS AND LOCATION------------?-3 L ` ---------------------------------------------------------------------------- ,. Owner's Name -0-��`---�a .4---9 5 4 Phone Address-----------------------------' ------------ ---_A v- ' `---------------- - //�- ---------------------------------------- --------- Contractor's Name-----------49r-ic--E---- ` _U-tl _Q- ------------------------------------------------------------------ Phone `--,�---fes- Installation will serve: Residence'A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths V Lot size____ _-----_______---___ �►I Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well-----------------Distance from foundation- ______-__-_____.Material_-_-_______-------------_-_----__-------___-_---. r ❑ No. of compartments--------------------------Capacity—--------------------Size----------------...............Liquid 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------------------------------------------------ 1 !' Seepage Pit: Distance to nearest well-------------------_-_Distance from fo ndation--- __-_-.Distan der to nearest lot line--l- ✓__---_ Number of its___---__ - p' �---------__Lmmg material_9_�--�-c.__�Size: Diameter-----3-4---- -.Dep+h_--_-2-_/_�__----__-- Disposal Field: Distance from nearest well---------------Distance from foundation_---_/;-�7 .---.Distance to nearest lot line-_1-:'2.,----_- " Number of lines--------1-------------------------Length of each line------44- -�-----Width of french------. -z�---------------- I / Type of filter material-- --qhs. ,-Depth of filter material------1- ' Remodeling and/or repairing (describe):-----'----------� �---------- e- { --- ------------------ ------- -------------- ------------------------------------------------------------- --------------- - ----------------- ------ ---------------------------------------------------------------`------------------------------------------------------------------------------------------------------------------------------------------------------------- f I hereby certify that I,�+a�e p�r,eepared this application and that the work will be done in accordance with San Joaquin County ordinances, S+ate-I an runes afid regulations of the San boaquin Local Health District. - f (Signed) -1 - =--------------------------------------------------------------- ��t.ractorj By:--------•-- - ---------- -- --(Title}- ------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this applicatJoni. FOR DEPARTMENT USE ONLY # I APPLICATION ACCEPTED By--------------- - ---------------------------- DATE--------- "`� 1_4 REVIEWEDBY--_-------------------------- ------------------------------'--------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ----------•-------------------------------------------------------------------------`----------------------------------------------------------------------------------------------- --------------------------------=------ i ----------------------------------------------------••-------------------------------------------------------------------------------------------------------•-----------------------------------------------------•---------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- ---------------------------•----------------- ---7--------------- ----- -------------------------------------- ------------------------------ PERMIT No. ---. -------- ISSUED---- -_7f<_ _-__. __ _--(Date) FINAL INSPECTION BY:------------W-ll__----------------------__------------- Dte---------------------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639