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APPLICATION FOR � I R SANITATION PERMIT' (ffPomple+e in Duplicate) Application is hereby made to the San Joaquin Local Hsalth District for a permit to construct and Inst 1 This application is made in compliance with County Ordinance No, 549. all the work herein described. JOB ADDRESS AND LOCATION________ Owner's Name------------------ - -"" - - _ Je_Ad ---------`i' dress__.----•--------------- ---- --------------------------- ---- (� p "„� o Phone_" � Contractor's Name say --- -----�t?_C fit- e9 - 7�- P jQ -------------------- Installation will serve: Residence h C`--------- ------- Phone-----p Apartment House Phone----- Residence . Commercial "-'"" � Number of living units: ❑ Trailer Court ❑ Mote! ❑ Other ❑ m Number of bedrooms �Number of baths Water Supply: Lot size-:__�_-_- Public system ❑ Community system "- Character of soil to a depth of 3 feet: Sand Private J� �� ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay I] Adobe❑ Hard an TYPE OF INSTALLATION AND SPECIFICATIONS: C ❑` (No septic tank or• cesspool permitted if public sewer is available within 200 feet.) Septic Tank: El Distance from nearest well-----------------Distance from foundation-------------------- No. of compartments"-------------------------Capacity---- - Material----------------------- Cesspool: ---=---�------------- ------Size_• --- Distance from nearest well Privy: from foundation_______________.__Lining maternal Liquid depth Size: Diameter-------------------------------------- i PrivDepth-------------------------------- ----------- ❑y= Distance from nearest weft _______________ __ Distance to nearest lot Line_---.--,-_ ------------Distance from nearest building _ 9 ------ eepage it: Distance to nearest well---1410-1 , Distance fro oundation-_ry Number of pits- �'=�_"--____.Distance to nearest lot line___`f --------0----------Lining material------------ Disposal Field: Distance from nearest well------------------Distance from foundation-------------------- D Distance to nearest �` -----.Depth----- ------ ----------- ❑ Number of lines------------------------------- t lot line__________-"_____ • ---=__"_--Length of each line----------------"--.- _ Type of filter material--------------_ ----_- Depth of fitmaterial-________-_-- Width of french----------------------------------- ter Remodeling and/or repairing (describe):---------------_ ----------------•--64-" �+a '!�( Ci -------------------- ------ ------------------ - ---------- ------- - ------------------- --------=-- --- - ---��- ----------- ------ ------------------------------------- ere y certify that I have"prepay d his application and tha} }he work will be done in accordance with San Joaquin County ordinances S laws, a ales ancf re a+ions of the San Joaquin Local Health District. {Signerd - f t I �- C ------------- Contractor)"' (Plot owing ► ---------- -= (Title)-- of lot, location of system ' relation to wells, buildings, etc., must be filPdwith +his application). FOR FOR DEPARTMENT USE ONLY+ � APPLICATION ACCEPTED BY--------- , REVIEWED BY -- --- --- -- ------------------------------------------------------ DATE--------- - - --------- { BUILDING PERMIT ISSUED----------------------------- ------ ------ ------- ----- ----- ----------------------------------• DATE Alterations and/or recommendations:------------------------_ --------------------------------------- DATE------------------------ --------------------------- C__._A Y --.--------------------------------------------_--------------------------------------- ------------------------. ------------------------------.----------------.-------------------------------------.__- n h�Y ------ I---------------x'+''. •--------•---------------------------------- - ------- - ---------------------------------------------------- ----------- PERMIT No..---f ---------- ISSUED---f_' _ S (Date] FINAL INSPECTION BY:_®_�"'------ f Date- --� T SAN JOAQUIN LOCAL HEALTH DISTRICT ! 130 South American Street ES-9-21vf'9-50 W-1539 Stockton, California