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41 ; +, 1 1 - APPLICATION FOR SANITATIONn I� PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct This application is made in compliance with County Ordinance No. 549. Y ' t and instal! the work herein described. JOB ADDRESS AND LOCATION__ Owner's Name----__--- - -- _ --- ------- ________________•______ ____.___________________•---------------------- 4 Address-----------•---- ----- y Phone-Z__-� Contractor's Name_------- ----------------------- -- -- - -- -- - --------------------- Installelon will serve: Residence L� Y � RApartment House ❑ ommercia! - - Number of living units: 0--cumber of bedrooms �. ❑ Trai er Court ❑ Mot ❑ Other ❑ Water Supply: umber of baths Lot size-----------! " pp y. Public system ❑ of system ❑ Private � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla : Y ❑ Adobe TYPE OF INSTALLATION AND SPECIFICATIONS: ardpan ❑ ' (No septic tank or ce s ool er -tted if�ubjjcseweravailable within 200 feet.) 4P6akh ?aom wei No, of compar encs____- e from foundation__�__-_____-_ ---Capacity-- - -----.Material----------------------------------------------- ---------------- - ----------------Size-------------------------------- ess ool: Liquid depth--------------------------p Distance from nearest well -----------------Distance from foundation__________________--Lining material______"-"__--___ ❑ Size: Diameter------------------ ` , a -------------Depth----- J Priv - y' Distance from nearest well------------------------------------------------- -------- --------------- Distance from nearest buildin ❑ Distance to nearest lot line_______________"_-_-- ---- g----------------------------- Seepage Pit: ------------ Distance r ------------------- to nearest well,"____"_____ ----------------------Distance from foundation--------------------Distance to nearest lo} line________ ❑ Number of pits-----.:_-------------Lining material_-_________" �. Size: Diameter ----------•--- -- , Disposal Field: Distance from nearest well -rQ---"-_.Distance from foundation__- Depth Number of lines_____;______ -____.Distance to nearest lot line___ I ___Length of each line____- _ �! Type of filter material____ j....a Depth of filter material___" 1I Width of trench______ Remodeling and/or repairing (describe ------------- . - ------------ -� -- ------•--- ------------- ---- -- - ---------- 4 ______________________________________________________________________________________________ ______ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 9 tY , (Signed)----4-/ Coun ----------------- -----------•---------------------------------------------------------------------------- By:_-.--•-------------------------------------------f- _(Owner and/or Contractor) tractor) (Plot plans, showing size of lo}, location of sys+em in relation to wells, buildings, etc., must beefiled with this application. } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYtREVIEWEb BY----------------------------- _ ---------- ---------------------------------------- --=- --- -- - - - _ DATE -----------------1LDlNG PERMIT ISSUED-------------------- --_ DATE -------" ------------- --- ------------------------ Alterations --------------------A terations and/or recommendations_____--- ------------------- ---------- ----------- --_-_- _- - ---- ---------- --- DATE-- -------- ---------- -____. ____________-_____-___.___-__ jr-------- ---------___ ___________________________ ______"________________________________ __ __-______ _________________ ___________ --- ---- �___ • F --------- --------------- 9 ------------------------- - PERMIT No.--- /,; s --;?-C-- -- ISSUED-----�- ']- -------------------- -------- - l (Date) FINAL INSPECTION BY ------ _ - l- ---.-- ,..: Date u, ^-- --•----------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT -.4 130 South American Street >' ES-9-2M 9.50 W-1639 Stockton, California