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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.- �"_---*�-------�--� ----- - --- Cr ,� _ _ +"" Owner's Name------------ r-- i l+ ------------------------- --------------------------------- ------------------- Phone -----------•-- - - - - --- ----- - Address-----------------------sr� '"-1 ..�'------_----------------------- -- - Contractor's Name... +.J ---- -` " --- Phone---------------------------------- - -- ---- - ------ -- --------------- --- Installation will serve: Residence V Apartment House E] Commercial ❑ Trailer Court ❑ Mote E] Other E]Number of living units: [� Number of bedrooms Z Number of baths Le Lot size____ _ � ___ _ Wafer Supply: Public system ❑ Community system ❑ Privatex 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_sgwer is available within 200 feet.) ''�' "'"""�� Septic Tank: Distance from nearest well___ ____Distance from foundation--_y� __ ___.MJ9teri If,_-Q_-IV qe:_ _��_f____t.y,, No. of compartments---------*__�_3__-----------Capacity----�0---I______Size-----�_-�._.�__�_�.Liquid depth----�- ISpool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------------------__ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: ------------ -- - - - - -- --- -------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------___.____ ❑ Distance to nearest lot line________________________________________________ 'Seepage Pit: Distance to nearest weEl----------------------Distance from foundation--------------------Distance to nearest lot line___________-_____ ❑ Number of pits----------------------Lining aterial-----------------I----Size: Diameter---------------------_.Depth------------------------------ 4Disposal Field. Distance from nearest well_27- istance from foundation___ _Distance to nearest lot line___•___-___ Number of lines-------- _:_ Length of each line______.__�'g Width of trench_--` — Type of filter material____ __ _t _ Depth of filter material______1�__ ______ Remodeling and/or repairing {describe= '` --- -• --------- ----------------------------------------------- ----------------------------------•-----------------------------------------------------------•----------------------------------------------------------------------------------------------------------------------•-------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prep red this application and that the work will be done in accordance with San Joaquin County ordinances, Stafe—taws, an Tiles a regulations of the San Joaquin Local Health District. � e(Signed)- r------ - --------"--- �--------------------------------------------------------------- WP1�r� polft� ntractor] 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----------- REVIEWED -------- rREVIEWED BY------------------------------------------------------------------------------------------------------------------------------ DATE---------------------------- -- - BUILDING PERMIT ISSUED--------------------------------------------------------------- -- ---------------------------------- DATE Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------•---------------------------- ---------------------------------------------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------`------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------- PERMIT No./_'T-_ ISSUED------._-7 � `' _-----{Date) FINAL INSPECTION BY:---- Date---------------? / 14-f ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ,,-ES-9-2M 9-50 W-1639