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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 install tate work herein described. This application is made in compliance with County Ordinance No. 544. � JOB ADDRESS AND LOCATION_____ ___ 2______ - f fle-mZ ----------- Owner's ----__- . Name_..._ _ _ �,-s ` -- - --- ------- Phone --- Address ------ --- /_ -- - - --- - --------- Zw Contractor's Name... --------- Phone-:7r Installation will serve: Residence Apartment House ❑, Commercial ❑ Trailer Court ❑ Mo#el [I Other ❑ Number of living units: ] -Number of bedrooms Number of baths t Lot size---/_1044-l-----�_ti4-:®_!-___----__ -------------- Wafer Supply: Public system ❑ Community system E] Private ' S Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam-E] Clay ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well_________________Distance from foundation---------------------.Material _______________________-__________---_--__- No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- Cesspool: 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 well----------------------Distance from foundation---------------------Distance to nearest lot line________-________ , ❑ Number of pats = Lining material. ----------Size: Diameter-----------~ _ .Depth--------_----------- _ Dispo al Field: Distance from nearest eIl ,',��1_--Distance,fcam #oundatian r R �— -- - —.-- - Distance'to nearest Jo} line______ Numb ('lines________ _ Length of each line______-- -�------ --�-_y�/idth of trench____-- -'_E- :�p -------------- Type of filter material/., __'__W Depth of filter material____-- _� '__ Remodeling.and/or repairing (describe):----------------------------------------------- ------------------------------------------------------------------------------ ----------- a ---------•------------------------------------ --------------------------------------------------------------------------------------------------------------------------•--------------------------------- 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. nn vmwA ?TmdAor 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 ---- _-- --- ---------------------------------------------------- DATE �- REVIEWED BY --- - - DATE = ---- ---------------- -------------------- -- -------------------- - ------------------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------- -. ---------- ------- --------------------------------------- DATE---------------------- Alterations and/or recommendations:_____________________ _ ------------------------------------------------------------------------------------------------------ ------------•---------------------------------------------------- RERMIT No.__-- -------- ISSUED-------1 '-- /----------(Date) FINAL INSPECTION BY:------ ! �.F Date--------------//_�,° -� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street f Stockton, California >:5--4-2M 9-5U W=I b39