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Y. 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. M1 This application is made in compliance with County.Ordinance No. 549. I >r2-- --a- LV, 77j Q� -------------------------------------------------------------------- JOB ADDRESS AN LOCATION---------- -- ----------------------------------------------------- -- Phone Owner's Name 9(:!t*;7 --- --- - -- ------------------------------------- ------------------------------------------------- Address -------------------------- ------------Address------------- ---- Phone----------------------------------- - ------------- -- Contractor's Name----------------------------------------------------- -- ---------------------------------------------------------- - Installation will serve- Residence Apartment HouseF-1Commercial F1 Trailer Court El Motel El Other ❑ Number of living units: Number of bedrooms Number of baths t] Lot size_ "------ - ri O ---------------------------------- Water Supply: Public system 0 Community system ❑ private ❑ Character of soil to a depth of 3 feet: Sand El Gravel El Sandy Loam [IClay Loam [I Clay E] Adobe Hardpan El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----`�=Distance from foundation____ +D__�__Material___- ---------- R i3'O--------Size_-_ = �+ Liquid depth__,�_�- Na. of compartments------__��_�__----------Capacity---�."-- - Cesspool: Distance from nearest well-----------------Distance from foundation_____________- ._.Lining material------------____._ ------------- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: ------------ ---- - ----- ------- ------------Privy: Distance from nearest well----------------------------------- -------------Distance from nearest building----------------------------------------" ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation_____--_______----.Distance to nearest lot line--_______--__171 ___ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------Depth----------------------------- ..Disposal Field: Distance from nearest well------------------Distance from foundation___._____; ---------Distance to nearest lot line_________________ i ❑ Number of lines-----------------------------------Length of each line------------------------------Width oftrench----------------------.----- Type of filter material------------------------- of filter,material___---____.___-_______ Remodeling and/or repairing..(describe):----_---------- - - - - ----------- ------- ------------------ ---------------------------------------- ------------- - --------------------------- -------------------------------------- ------- - ------------------------ --------------------------------------------------------------------- I hereby certify that have prepared this ap lli the San Jothat i the work Heawill l beDis done n accordance with San Joaquin County ordinances. State laws, a esre9u + � for Contractor) (Signed _ C-- TIru __ _ ( it e) --- --------= buildings, etc., must be filed with this application). (Plot plans, showing size of lot, location of system in relation to wells, FOR DEPARTMENT USE ONLY APPLICATION' ACCEPTED BY________---___--___- ------------------------------------------------ DATE------------- - d ---- ------ REVIEWED BY---------------------------------------------------- -- -------------- - - BUILDING PERMIT ISSUED--------------------------------------------------------------------- ---------------------- ------ - DATE------ -------- -----------� ---------- ------------ ----- ------------ ------------ Alterations and/or recommendations:------------------------------------------ = ; ------ _----- _ --- --- --- - ------- - _� ---- ---------- ---- -- - ------------- ---------------------- _ ----------------------------------------------------------- - ------------ --------------- PERMIT No._) ----------- ISSUED------ ..... - - IDate} FINAL INSPECTION BY------- ----------------------- ------------ -------------- f 3 '-f -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-9-2M 9-50 W=1639