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J 'ell APPLICATION FOR SANITATION PERMIT /0-a0- 5 A . (Complete in Duplicate) Application is hereby made to the San Joaquin.Local Health District for a permit to construct an)inall t �I kn�ddescribed. Th,s application is made in compliance (th`Coein4y_Or ante 549. JOB ADDRESS LOCATION- ��- U — 'r--'- - Owner's N i .. --------- --- ------------------ = -------------------- Phone - -- 4 AddressILII f- -! --- - ---------- ---------------------------- -------------------------------------------------------------- �~' Contractor's Name �- ��.-------- -- ' Phone ------------------------ ------------- -`-• .�`- - ------------------------------------------------------------ Phone will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [ umber of bedrooms [ Number of baths [P Lot size-_45__10----- __Z- 0-----------------------_ N Wafer Supply: Public system Community. system ❑ Private E] � I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[2/"Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if publ�i�c�s/}e�er is available within 200 feet.) Septic nk: Distance from nearest well-_-- ._ '-Distance fro f undation-------I_ _--.I�fateri�l____________ ___ --------- _ y T Na. of compartments___e____--_-__ Capacity_-_�- ____ S x�_ 4s-.Liquid depth---_.-- - (/ L/ Size Cesspool: Distance from nearest we11-----------------Distance from foundation------------_______.Lining material------------___-_------___---_---__-- ❑ Size: Diameter------ -------------------------------Depth---------------------------------------------------- {{� Privy: Distance from nearest well________________________'__-__-_-----_-_------Distance from nearest building----------------------------------------- - ❑ Distance to nearest lot line________________________________________________ • � r Seepage Pit: Distance to nearest well_1 -ire, -_---Distance from foundation---&o'----Distance to nearest lot line----------------- Number _fv___----_Number of pits------- -------- __Lining terial_ h-Qx,____-Size: Diamete�r__ .��` Depth-AF Dispos Field: Distance from nearek__' t I 2- - .y„' �Y Distance from foundati�--��----`-- --------Distance to nearest lot-li`n �. ..Yrs f 4 Number of lines_______ _(___._-_ ___Length of eac0ine.--__ - -_ _ at.Width of trench----__-_- -----.--_-____------ Type of filter materbepth of filtematerial____--__._�- __- Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ ------------------------------------------------------ --------------------------------------------=-----------------------------•------------------------------------------------------------------------------- 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 d' regulations of the San-Joaquin Local Health District. (Signed)_._I _ --_- - - -- •- --- ------- -------------------------------------------------------------------------- --------(Owner and/or Contractor) B ' (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. 9Y- REVIEWED Y - = - DATE ------------------------------------------------ --- REVIEWED BY -- - - DATE BUILDING PERMIT ISSUEDA----------------------------------------------------------------- Al+era+ions and/or recommendations- ----------------------------- ------------- •------------ -"-'-- --------------------------- -------------------------------- V ---------------------------------- e -7 !4-k- ------------------------- -------__� d __ F ----------------------•------------------------------------------------------------------------------------------------------------ -------------------------- • --- -^` ------------------------------------------ -----------------------------------------------------------•--- --,---------------------------------------------------------------------------------------------- PERMIT No.--' -- - --- ISSUED---f_d---- -. -vz.(Date� FINAL INSPECTION BY:--- -----_--' ------------------- // --- ------------------ Date { 7--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street , Stockton, California E5---9•-2M 9-50 W-1639