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�sl APPLICATION .FOR SANITATION PERMIT (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 with County Ordinance No. 549, JOB ADDRESS AND LOCATION----- Owner's Name------------k----------- zL4-5_ Address------------------1 9_j---I----- --------------------- Contractor's Name____________________ _ ____-----_-_-- Phone---- Installation will serve: Residence - Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ® Number of bedrooms [I. Number of baths 0 Lot size---- _-_ .�------------------ Water Supply: Public system ❑ Community system ❑ Private Character of soil to a depth o 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material❑ No. of compartments--------------------------Capacity-----------------------Size----------------------------._._Liquid depth-------------------------- Cesspool: Distance from nearest well------/&D _Distance from foundation--------)- r----.Lining material_G� _ Size: Diameter------- I------------------------ 0 Depth-------------------3------- --------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- to nearest lot line__------_------_- - ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth_____-_____----____------------- �d Disposal Field: Distance from nearest well-__ + _____Distance to nearest lot line-----)_�_D-----Distance from foundation--- -_- __ - Number of lines------------{----------------------Length of each line-----------kf`�_ -_--_-----Width of trench__72.34_1`------------------ Type of filter material---f0-C �------Depth of filter material_-----'1., 11 Remodeling and/or repairing (describe): 4_0 -'A�_-4-----W_ ---- - ------------•-----------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. Si ned ` �Q } ( 9 )•----- -�---#..�>�-�� •e..--------------------------------------- ------------- ----- --{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------------------------ - -- --- - ----- --- QATE___-____-- -- ------------------------------ ------ - REVIEWEDBY --------------------------------------- v_------------------------- ------- DATE- -------- --- '/ , BUILDING PERMIT 1SSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations-----------------------------------------------------------------------------------------=•-------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------•------------------------------------------.--•--------------------- ------c---------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------—------------------------------------------------------------------------------•--------------------------------- --------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------f-- ----------------------------- PERMIT N - _-- ISSUED--------- ---�`v` �S��ate} FINAL INSPECTION BY -- 1711- - Date -- 'r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California i 5S-9-2M 9-50 W-1639