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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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----------- /-4-XI-------1, ).........--��J -------------------------------------------------------------------------------------- Owner's Name '�(_ _-� ty - - Phone------ / Address-----------Sib ' —------------------------------------------- -------- - - ------- -------------------------------------------------------------•--- Contractor's Name--------- ----------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ;, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .m Number of bedrooms Number of baths ❑ Lot size------�p _, _ Qpp_______________________ Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Id Hardpan ❑ \ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) n Se�tic Tank: Distance from nearest well---- Distance from foundation_________________,Material_____YT Q--d-!4"_df/______________ /us No. of compartments_____-__.,�_'___ ____Ca Capacity _ ___Li Liquid depth._____.V--------------- ------ - Size Cesspool- Distance`ffdh)-- istance from foundation---------)--Z_Lining material-_-_,C- _t7113l--_---- Size: Diameter__ jf. t)t '� ""�pfh ----------- --------------------- 4 Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------------------------------ L1 Distance to nearest lot line---------------------------------______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- _-_.Distance to nearest lot line_____- ___ Disposa€ Field: Distance from nearest well-_- "_._.Distance from foundation--------/. �______ Lengtlk,of„eacb.line_--- _-_=_1. ._..,Width. of tra cb_.r_�`, :�� Number�of•Iines� _- _a Type of filter material-OX-7-2Depth of filter material-------/d°!°___---- Remodeling and/or repairing (describe ------------------ ------------------- -' — �-_----- c��A- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the 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)-------�size ---------- - ----------------------- ------------------------------ --------------------------------(Owner and/or Contractor) Plot By., , location of s temtion to wells buildin s etc. mustTbee)-i-ed wit-------'----------'--------------------------------( p y .- g , h this application). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY---- -------- ------ J ---- - ------------------------ DATE---- r 1 REVIEWED BY---------------- ---a.�---- _ — ------------------ DATE BUILDINGPERMIT ISSUED------------------------------------- - - ------------------------------ ---- DATE- - ---------- ------------------------------------------ 7- Alterations ----------------------------------------- wAlteratio s and/or recommedations---------------�; _ - ------- -------- ----- -----_--_---------_ --------------- ----------- --------------------------------------------- --------- ------ ---------------------------------------- ---------------------------------- ?----------------------------------- ISSUED----v PERMIT No.__�'7p 3_a� _______(Date) FINAL INSPECTION BY:---------- Date-----------------------I- +' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-9-2M 9-50 W-1639