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PPLICATION FOR SANITATION PERMIT (Complete in Duplicate) is�*' t for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Luta! Health D' �s application is made in compliance with County Orclinanc<�'O, 549. .4------ t- ----- -- - ------ ---- JOB ADDRESS D LO TIO --- Pj------------------------- vtrs� �__ Phone------------------------------------ PPLICATION F1 D L .. ... ?__6-------1-- ---------------------- Owner's Na e------- ---- -- ------------------------------------ Phone ---------------------------------------------------------------------------------------- ----- -------------------------------------- Addre: ---------- I-- ----------- - ------ - Contractor's Name---- ------------------------- - ---------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House 0 Commercial [-] Trailer Court [-] Motel L] Other 0 Number of living units: -$ Number of bedrooms I Number baths [t Lot size_____ -----------X116dy I ----------------- Wafer Supply: Public system E] Community system E] Priv "PVMardpan E] Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet] Se ank: Distance from nearest well C5J9 Distance fr fo daT1Un_jA,__, ate I{___------ -- - ----- - ----------- -- -------- pV1 No. of compartments----------2V---------Capacity -------Size .. ......exIg-L i q u i didepth________� 4 ------------- Distance from nearest well-----------------Distance from foundation--------------------Lining material-_------____--------_-------_____--- Size: Diameter--------------------------------------Depth---------------------------------------------------- 1A_'Z q- Privy. Distance from nearest well_____________________________________--_________Distance Distance from nearest building_____________-_______________-_-___-_____. ❑ Distance to nearest lot line________________________________________________ Seepage ine------------------------------------------------ Seepage Pit: Distance to nearest well----------------.-----Distance from foundat;on--------------------Distance to nearest lot line--_-_-_-__--_____ r n ❑ ine----------------- El Number of pits----------------------Linin Tate ial-----------------------Size. Diameferj----------------------Depth-----------------------I---------- Pispo.saKielcl: Distance from nearest I I Distance from foundation 5---- T W _-_Distance to nearest lot line lot Number of lines___________ Length,of each line-------------- of french-------74-------------------------- Zw_ lepth of filter maferi I---------- Type of filter materi ----- a -43------ Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- I -------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- ----------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I 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. (Signed)---- _ - ,V--------------------------------------------------------------------------------------(Owner and/or Contractor) 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 -Z- -------------------------------------- DATE E_�_ �------------------------------------------------ REVIEWED BY---------------------------- DATE---e BUILDING PERMIT ISSUED--------- - DATE --�-1� --------------------------------- ------Alteraf�ons_ nd/or recommendations:------A-----1------- ------- -------------- .... ----- --- --------------- --------- ---------- ------------------ &�_ _ ------- ------------- --------------- --------------------------- ---- -- - ----------- -------- - ---------- ---------------- --------- --------- --- ----I--------- ----------- --------- .............. ----- ----------------------- --------- '74_ev A r__&--------------- `2- 7 -- - -- ------------ ------------------------------------------------------------ ------------------------------------------------------------------------------------- --------- - -- ---------- ------- ---- PERMIT NSX__V--------- ISSUED- -------(Date) FINAL INSPECTION BY:_---. - - ---------- ------------------------------ Date-------------- ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-9-2M 9-60 W-1639