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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 to construct and ins#all the work herein described. This application is made in compliance with County Ordinance No. 549. 05ff— oeo "(t� JOB ADDRESS AND LOCATION-_3-ITZ__1-14*.- a2.-- Owner's Name_- _ ----------------------------------------- Addressa- s-- -- -------- --------------------=--------------------------- Phone---- �v. --�- .r -_ _ . . � Ste-------------------------------------------------------------------------------------------------------------- Contractor's Name ------------------`� Phone Installation will serve: Residence Xc Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 00 Number of living units: Number of bedrooms J5 Number of baths 0 Lot size___________ _____________________� Water Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [X Clay ❑ Adobe ❑ Hardpan I _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from foundation----Z�_¢__-__ Material.__ " I No. of compartments-------------------------Capacity-----�--------------Size-------------------------------Liquid depth---------------j•Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- F1Size: Diameter-------------------------------------Depth---------------------------------------------------- .'Privy: Distan e from nearest well_______________________________-______________Distance from nearest building________-____________________❑ Distance to nearest lot l ine________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line___________"___ ' ❑ Number of pits----------------------Lining material--------------_--------Size: Diameter-----------------------Depth------------------------Y_-_---_ i1 I LDisposal Field: Distance from nearest well___------Dist�ce foundation----1_4__�_____Distance to nearest [of line---�s,_ _ AA Number of lines--------- _41.___..+----_--Lengt �ef�l- --------/0p'-- -_-- Width of trench-----------'1- "- -----_-- Type of filter material-----l j_+ :Depth of filter material----------- Remodeling _________-Remodeling and/or repairing [desc 'be�--- - ----- - --- - ti----- ----- f------- tl'q't-i"^-- ---- - r0� ' ��'� ------- ------------- --- - ---- -------------- ----- �`- --- Y ------- ---------------- ------- V-rr g-a---- --- ------y------------- k - hereby certr that I have prepare�=is pplica n and that the wok will be done in accord nce with San Joaquin County i ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. ISi ned ( g ) - (Owner and/or Contracto ----------- -------------- ------------------------- a �� By:------ ------- ------------- --"ion - - --------- - -------------------------------------- ------------(Title)--------------------------------------------------------------- (Plot plans, showing size of lot, Iotf s min relat in to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- q, DATE____--____ REVIEWED BY-------------------------------------------- _ DATE_-------------------- R ------------------------------------- -------------------------- BUILDING PERMIT ISSUED---------------------- - -- - ---------------------- DATE----------------------------------` ---: ------------------------------------------ - - --------------------------- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------------------------------- ~_-- q -- ------------4-e-11------ ----------------------------------------------------------------------------------•----------------------------------------- -------------------------------- - ---------------------------------------------------------------------------------------------------------------- - - - ------------------------------------------------------------------------------------------------------- PERMIT No------- __��---------- ISSUED_---I -Ia- _5 -------------•-----(Date) FINAL INSPECTION BY:----_------------ -------------------------------------------- Date---------------------------- ---V--:FV--------------------------Date---------------------------- SAN JOAQUIN LOCAL_ HEALTH DISTRICT 130 South American,Street Stockton, California 1 1=S-9-2M MO Wd639