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r APPLICATION FOR- SANITATION PERMIT (Complete in Duplicate) made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby t Ordinance No. 549. /.•- y V , This application is made in compliance with County � A4 �' JOB ADDRESS AND LOCATION------------- ------------ ------;C--07 - -- Phone----------------------------------- � f. C�� fr� - f Owners Name----------------------------------------- --- Address ------------------- -------------------------------------- Contractor's Name--_---------------•-- lino,al ❑ ther ❑ Installation will serve: Residence Apartment House El Commercial ❑ Tras4er Court [I o VV ing units: [B/Number of bedrooms El' Number of baths ❑ Lot�size------------------------------------------------------------ f---------•------ -- -------------------- Number of lov Water Supply: Public system ❑ Community system ❑ Private - � Sandy Loam El Clay Loam El Clay ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel F1Adobe❑ Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public�sgwer is available within 200 feed l Se tic Tank: Distance from nearest well----------____----Distance from '5da{i5 ie__.-----------------------------aterial Liquid depth_-_______---------------- per/ Capacity No. of compartments_______________ _ Ca acct _____ Cesspool: Distance from nearest well-----------------Distance from foundation_-_________________.Lining materia_.___------------------- _Depth.-------•------------------------------------------- ❑ Size: Diarrseter------------------------------------ ------------------ Privy: Distance from nearest well______------------------------------------------ Distance from nearest building ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well-------_--min mDiitan a fro =founds ze: Diameter----�-stance t--Deepthst lot --------------------- Lining ---------- -- ❑ Number of pits_____________ 9 r Dis osa ield: Distance from nearest well_____-__�a_.Distance from foundation___ Distance to nearest lotc '------- r P --��-Width of trench----------------------------------- [Z ---------------------- ------- --- Length of each line__________________ _ ____- Number of lines-------------------�-------r----- g - Type of filter material_____-_ i ----Depth of filter material_______________________ ----------------------•-------------- ------------------------------- ---------------- Remodeling and/or repairing (describe)-------------------------------- --------_-____-----_------------ ------------------•------------------------•------------------------------------------------------- ------ ------ ----- ----------------- --- --- --- --- - ----- I hereby certify that I have prepared u�a}sonspli the San Joth aquin h Lowork cal Health beDis done n accordance with San Joaquin County ordinances, State laws, and rules/An rLr �! Contractor) ' -___(Owner and/or �/ � (Signed)-------•---•n------'-•------------------------------- Title By=---------------------------------------------------------------------------- ---- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY DATE---------------------' -` L_�-------------------- APPLICATION ACCEPTED BY ----------------------------------------------------- DATE----------------------------------------------------------- REVIEWED BY----------------------------------•------------- ---------------------------------------- ------------------------------------------------------------ ------------------------PERMIT ISSUED --- --------------------------------------------------------- Alterations and/or and/or recommendations:____________________ --__.________-_________-------_--• --- ------------------------------------------------------------------------------------- -------------------------------------------------------------- 3� i y Date FINAL INSPECTION BY: PERMIT No------------------------- ISSUED (Date) Date----------------•--- ----- ' ``'3 ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--,9-2M 9-50 W-1634