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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) _ t Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. _- ----------- JOB ADDRESS AND L C TION _�� ---- ------------- -------------- -------------- --------------- Owner's Name_ ------------ --------- ----- ----------- --- ---------- Phone Addressl7 ------------------------------------------------------------------------------------- ------- L Phone -------- ------------------- -Contractor's Name----D __A =--- -,ee..:-.,-a`'�"` o-9 --------------------------- - .Installation will serve: ResidenceApartment House F1Commercial F] Trailer Court E] Motel [IOther E] Number of living units: Number of bedrooms Number of baths Lot size___ ____!_ -5---------------------------- Water Supply: Public system Community system ❑ Private 0 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 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 well---_-____-____Distance from foundation____..90-------Material__ ' ----------- Id depth- ---------------- No. of compartments---- e---------------Capacity---Wd? ------ ------Li_ a Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material--------------------------------------- F1Size: Diameter----------- --------- ---------------Depth---------------------------------------------------- ______Distance from nearest building - Privy: Distance from nearest well --------------- ------------- - 9------- ---------------- -_-------� ❑ Distance to nearest lot line------------------------------------------------ Seepage ___________________________________ " - Seepage Pit: Distance to nearest well----------------------Distance from foundation`_-------------------Distance to nearest lot line--------------- 0❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- ,•..Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line________________- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material------____.__________ Remodeling ,and/or repairing (describe):---402ir � ' -- ------ - ____ _________________________ " 6 f __ ______________________ __ _____________________________________________________ ____ ----------------------------------------------- ------------ ----------------------------------- ----------------------------------- ------------ ------------------ - -------------- ---------------------- hereby certify that I have prepared this application-and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f, 1 Si ned GwmeraPd/or Contractor] (Signed], °-�,'----------------------- ------------------------------ '1 By:-- (Title)- - -------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ------- DATE------____ --------------------- r --------------------------------- REVIEWED BY----------------------------------------- ------------------------------------------------------ DATE------- --------------- ---------------------------------- - -------_- BUILDINGPERMIT ISSUED------------------------- ----- -------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations---------------------- ------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------- - ---------------------------- -- ----------- ---- ----------- ----- - ----------------- ------- -------•--------------------------------------------------------- ----------- --------------------------------- -------------- - - - P;=RMIT No, Y_ ISSUED______ __ r ____1"�------(Date) FINAL INSPECTION BY_____________ _ ___ -- ------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT UC 130 South American Street Stockton, California ES--9-2M 9-50 W-1539