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y r � " APPLICATION FOR SANITATION PERMIT 7 �� (Complete in Duplicate) 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 • h County Ordinance No. 549. JOB ADDRESS AND LOCATItVN- ------------------- Owner's Name_____________ - ------ --- --------------------------- Phone------------------------------------ Address------------------------�•--------- ----1-�---------------- ----- ------------ ---------- -------------------------------------------------------------- -- -- ------- -------------------- Contractor's Name_____________________ � l - - -- ---------- -------------------------------- Phone------------------------------------ Number --------------------�-- Ins+allation will serve: Residence� Apartnt House ❑ Commercial,❑ ,Trailer Court ❑ Other Motel ❑ Number of living units: [� Number of bedrooms a Number of•baths $ Lot size_______ Water Supply: Public,system [] Community system ❑ Private Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe❑ Hardpan ❑ X TYPE OF INSTALLATION AND SPECI'FI'CATIONS: (No septic tank or cesspool permitted if public gwer is available within 200 feet.) 7 Septic Tank: Distance.from nearest well____� ---_Distance from foundation-----1._EJ______Material__t----------------------- ------- _____________ ___ No. of compartments---__ ------------------------- K CepacitY �Q----Size----— Liquid depth----`7- i Cesspool: Distance from nearest well-----------------Distance from foundation____________--_ _. __ Lining material___________________________ ❑ Size: Diameter- er--------------------------------------Depth------- - ------------------- -------- --- ---Depth------- - ---------------------- - ----------------- Privy: Distance from nearest well________________________________________________Distance from nearest building Distance to nearest lot line_________ or 1 See ge Pit: Distance to nearest well___-__5_Q______Distance fro fou if Number of- its__.__ stance to nearest lot I�ae,� ,_ f D� P Lining materia , ' o . Diameter_'�r---•- De th ------- Disposal Field: Distance from nearest well___ ~_ ______Distance from fou'dation----%?_ Y_'___DistanceTtotnearest lot 1 `e_ Number of lines::__� __----------------- Len th of each lino_______ _ _i ---- 9 - pp ►f-----.Width of trench---�-�'--------- - ---------- Type of filter materials� �---Depth of filter material___ !__ Remodeling and/or repairing (describe):- ..5-4 ,--_� _ ® _ ------------------------------------------- ----------------------------------------h----- ----------------------------------------------------------------------- --------------------•- ---------------------- ---------------------------------•-------------------------------------------------------------- -------•------------•------------------•---------------- I herebycertify that I have Y 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)------4 - 2c _______(Owner and/or Contractor bY� ----- ---------------------------------------------------------Trtle __ (Piot pians, showing size ofrlot, n locatioof system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____________________--_----_C ----_ ----- - ----------------------------------------- DATE - - --t''�-• REVIEWED BY----------------- ----�---------------- ------------- -�- - �:�w,�-- ------------------------- ------ DATE----- �' UILDING PERMIT ISSUED --------------------- - - ------- --------- ---------- ------------ DATE------'�--------------------- Alterations and/or recommendations:____ -- ------------ -- -; PERMIT No.�_-T�-- -- ISSUED----- -t��___�_[_-�.3 /-/ __jDate) FINAL INSPECTION BY:__-_ _____-,______ Date - - -------- SAN --SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 , Stockton, California