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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Th is_application is,made in compliance with County Ordinance No. 549. J� �- i2c—Gk Z.4- f5 �. _s" ri4r -e. • I JOB ADDRESS AND LOCATION------------------------------------rx I r r-y-tj------. 4 S 4,w p ff is �C 1 R� - 7-ff,CiVc� CAn�F -- -------------------------------- Owner's Name '�'` • -�-�------------------------------------------------------------------------------------------------------- Phone -----fir---3-5--------- ;tl Address------------------------5 = I ----------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's ------------------------------------------------------ Contractor's Name---------------- -_ __�L�_!!}_l? 44+x--------------------------------------------------------------------------- Phone-_�_7��'_`� Installation will serve: Residence Apartment House F] Commercial E] Trailer Court F] Motel F1Other F1 ') i Number of living units: 9A, Number of bedrooms 13 Number of baths R Lot size--- _ ------------------------------------------ :Wafer __----G __________________________:Wafer Supply: Public system ar Community system ❑ Privatex 'Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ 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--------------------Material--------------------------------- .-_____________- ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material_______-----______--__________-__---_. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- 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----------------- . ❑ Number of pits----,-----------------Lining material-----------------------Size: Diameter--------------------_,Depth--------------------------------- Disposal Field: Distance-from nearest weEl_____ --a)____.Distance'from foundation----Z r_'-Distanc6 to nearest lot line____��___`_,�___ Number of lines_J_______��____ ___________Length of each line____-_;�-_m--------------Width of french------P___V__r................ Type of filter ma'erial__YA_ --�a_5.Z<__Depth of filter material-------/S__� Remodeling and/or repairing (describe)-------------� F ---------U'---*P-A__!_!)!'_A_0 C__4-------------------------------- ----------------------------------•---------------------------1----- ----------------------------------------------------------------------------------------------- -----------------------------------------------------------•--------------------------------------------------------------------------------- ------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- •---------------------------------------- I hereby certify that I have prepar this application and that the work will be done in accordance with San Joaquin County ordinances, Stat An -7-4es an ' re ulations of the San Joaquin Local Health District. 5i ned� .g )---------- ---- -- ---------------------------- --- ----------- ` ,qer_,an Jor Contractor) By:----------------------------------------------------- -- -----------------------------------------------------------------------Title ------------ E ;(Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with Phis application). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -------- DATE----------��.-._-� e ----------------------------------------- REVIEWEDBY --------- -------------------'------`------------------------------------------------- DATE-------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------1 ----- --------------------------------------------------------------------------------------------------------------------- - ----------------------------------- -------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ PERMIT No.__3_1__�___________ ISSUED__--_______�f__ !_�_________(Date) FINAL INSPECTION BY_____ Date---------------------- ----5-f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9.50 W=1639