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3 APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health Dist ricf for a permit to construct and install the work herein described. This application is made in compliance wi my Ordinance No. 5 .. .rd JOB ADDRESS AND LOCATI N_`' _ ___ _ - j 7 3 ---oso—`-Ct 6 "_ __ ---------------- -------"""_"_.. ----------------------------------------------- Owner 's Name----- - -----•----- - - --------- Phone------------------------------------ Address---------------- -- ----- -- -------------------------------------------------------------------------------------• ---------------- Contractor's Name___ ,_ t _^•,� � � ' p ❑-�`"° • ----------�------------------------------- ---------- Phone__17_� __ 6 Installation will serve: Residence Apartment House Commercial ' Trailer Court ❑ Motel ❑ . Other ❑ Number of living units: Number of bedrooms Number of baths ] Lot size__" 6_�___'_ _ Water Supply: Public system ❑' Communitysystem Y ❑ Private_ Character of soil to a depth of 3 feet: Sand El ❑ Sandy Loam ❑ Clay Loam 11 Clay ❑ Adobe Hardpan ❑ .TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we))-o17Distance from foundation---- -/0_"No. of compartments---------A-----------Capacity-, X � Matil ----------------- - 'K ze__ T-- Liquid depth---�.5,.2e / Cesspool: Distance from nearest well------------- Distance from foundation--------------------Lining material-------------------------- ❑ Size: Diameter--•-- •-----------------------------Depth----------------------------- - ----------- ` Privy: Distance from nearest well""""___"____""_ _----__-Distance from nearest buildin ❑ Distance to nearest lot line--------------- - - - g" Seepage Pit: Distance to nearest well-_A4- Distance from foundation_""- Number of pi#s____'"I" -- ------Distance to nearest lot line.... ---- Disposal i ., ----__--_--Lining material___'_' 1. Size: Diameter----- '' Depth -oZ I--------------- Disposal Field: Distance from nearest well_ _.p;stance from foundation-""l s Number of lines-" "-_,�"" t` --9---�----Distance to nearest lot f ------Length of each line------,,,10--- ----------- Width of french----- -�/e!------ ---- Type Of-filter material"�_"__- ��"popth of filter material___"�,� _ '""" Remodeling and/or repairing (describ�}----------------------- ----------------- ---------------------•------- ----------------------------------------------------•------------ --------- ------ ------------------------ -----------------------------------------------------------------------------------------------------=---------"-------=------------------------------------- I hereby certify +hat I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules andregulations of the San Joaquin Local Health District. (Signed)-- -- --�- --•--'�---�-- �"p'�" - - --- ------------ ----------------------------------------------•--------•------ rContractor) By (Plot plans, showing size of lot, location"of system in relation to wells, buildings, etc., must beefiled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- 4 REVIEWED BY ----------------- 9_ __, DATE -------- — - �--l -------- ------------------------------------ : DATE. ------ ----- BUILDING PERMIT 15SUED""""___________•---------- Alterations and/or recommendations: DATE -------------------------------- ------------- - - -- --------------- PERMIT No.-_,T-- ---- - ISSUED-----!-y s7 --------------(Date) FINAL INSPECTION BY:-"-"__"________" Date------ --------- �+� ; SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9—.2m 9-50 W- q Stockton, California