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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 compiiance.with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------- r------------- --------------------------------------------------------------------- Owner's Name___._.__ �---- � �1T- � �.as---S-chon-----1:236---YSe-hoo-1----------------------- - 5 Phone-------- — ---------------- Address 3 - -------•--------------------------------------------- -------- ---- Contractor's Name--------•---7�@a,�3..`�@ �i -------------- -- - - --------------------------------------- Phone will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court �Other Ej ❑ Motel ❑ Other ❑ Number of living units: •01. Number of bedrooms E] Number of bafhs [2 Lot size------60---x---100.2------------------------------ ! WafeSupply:Su I Publics stem� y ® Community system E] Private E]Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ' ❑ 'Clay ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a Septic Tank: Distance from nearest well________________. Distance from foundation--------------------Material----"""_-,- ❑ExiSt,lrigNo. of compartments---------------------------Capacify------------- -------------------------------------- ----- ----Size---------- ------------ ------Liquid depth-------------------------- S Cesspool: Distance from nearest well-----------------Distance from foundation___________________-Lining material_______ ____________________ _ El � < Size: Diameter--------------------------------------Depth--------------------------- Privy: Distance from nearest well -___""- " -----____-Distance from nearest building_________________________" ❑ Distance to nearest lot line Seepage Pit: D;sfance to nearest well______"______"_______Dis nce from foune�ation _:_"_________ f Distance to newest lot,line """" ""_"_ Number of pifis______- _"""" ""_ Linin ma rial ! - I T --- g -Src Diameter �� Depth_---- ------------------- Disposal Field: Distance from nearest well__________________D;stan -from-fo ndation-------------------- ® Number of lines---' ' I ________________Length - each line_ 'A ---- Distance nearest lot line of tre,�9h----€�.pp-.--a--8#t " a Type of filter material___-xQ-Ck--------Depth of filter material___ u _ Remodeling and/or repairing (describe): repare-Paix1ng-------------------------------- �p --------------------• ----- --------- ' - L__/ 4----�� --•--- Com' 7 � O r ------------- ---------- - .. hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Ca`unty ordinances, State laws, and rules and;regulations of the San Joaquin Local Health District. . (Signed)-----De It a � i ----T --aexc e -•------------------------------------------------(Owner and/or Contractor) -------- ------------------(Title),--- _____ (Plat plans, showing size of lot, location of system n r ation toWells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______________"_ REVIEWED BY = == --�yly------------------------------------------------------ DATE----------r/. - �f --------- • � --- - ----------------- DATE------------- _. BU1LDiNG Pl'R� II��I D--------------------------------------------------------- ------ -------` -- DATE Alterations and/or recommendations:__________�-_C _"Cr"___ _�{ `" w ---------------------- -------------------------------------------••--------------------------------------•----------------•--------------------------- ---------------------------•----------••----------- 1 ------------------------------------------- ---------------------- - ------------------------------ ----------------- PERMIT No.,%- ----7-------- ISSUED----l` -. .� - --- - ------ -------- Date FINAL INSPECTION $Y:---• -------------- -------- -------------------------�--- W '. Date / SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9.50 W=1639 Sfockton, California 1