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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) ' ` Z 74,0 Applica+ion is-hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described_ 'l This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN LOCATION---- -- - '` " ------------------------------------------------------------------ Owner's Name ----- Phone------------------------------------ { ----- ----------------------------------------------------------------------- Address----------- _-•--- ------ --- ` -- ----------- -- -------------------------------------------------------------------------------------------------------------------------- Contractor's Name........... _ �= !fit-----_--- ' sL.f.rJ Phone ------- Installation will serve: Residence ❑ Apartment House d Commercial ❑ Trailer Court ❑ Motepl L] Other L] r r �f Number of living units: ❑ Number of bedrooms Number of baths Lot size_____ __sf__ __�_ �_Q__ �------- Water Supply: Publics stem El system � .Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel Q Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeM Hardpan ❑ {�� + TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic Tank: Distance from nearesll__ _bb_ ____Distance from foundation 1A ___ Material-------- �.C.0 ------------- ®- No. of compartments____________ _____Capacity_/'0-_�_4_______Size___r� _ .Liquid depth_____- + { Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material_____.____-___,---------------:__-. [] Size: Diameter--------------------------------------Depth--------------------------------------------------- �a Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----_---------_--_____----__-___-___-____. ❑ Distance to nearest lot line------_---------------------------------------- �� f Seepage Pit: Distance to nearest well___ 64?__e'g__'m__aferial,__j6Xi0 Distance from found�tiorif_ ._____.Distance to nearest lof I'sne___� +_--_____ Number of pits___________________Lini � ize: Diameter____,___ ------- _�___``____________ Disposal Field: Distance from nearest well�aQ_t__.Distance from foundation___ �1 ______Distance to nearest lot line__f.r�_ Number of lines____ �___ / ______Length of each line_______�0__ _,-___.Width of french--- _ ��_______�__ Type of filter material1_%_lrkdkepth of filter material_______ Remodeling and/or repairing (describe)------------- ------ " ------------------------------------------------------------------------------------------------- _ 1 -----------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•- hereby certify that I have prepared this applica+ion and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ -- /' x --------------(Owner and/or Contractor) I3 •----- ---------!_`_.�_/1k� -�f.•C.,_.,-=''---------------------------------------------- T1tle �<� - + --------------------- Y• 'f ( } _ ..�._._ (Plot plans, showing size of lot, locAon of system in relation to wells, buildings, etc., must be filed with this application). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - --------- - - ------ ------------------------------------------------------ DATE------------Vin_!_ - - REVIEWEDBY--------------------------------- = ----------------------------------------------------------------- -- DATE--------------/Q`---t- ------------------- BUILDING PERMIT ISSUED----------------------------- : , --------------------------------------- DATE--------emr=---------------------------------------------- Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- ' -------------------•--------------------------- --------------------•-----------------------------=------------ --------------------------- ---------- ------------------------------------------------------------------------------------------------------------- � ISSUED------ e�L `3 ----_--_---(Date) FINAL INSPECTION BY: V PERMIT No.------- a � Date-------1--a-3-0--------- --p---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street a Stockton, California ES-9-2M 9-50 W-1639