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APPLICATION FOR SANITATION PERMIT 7-0 (Complete in Duplicate) j r �iCFfC f-i 3.�_ 2S5'— 310 —2--3 Application is hereby made fo the San Joaquin Local Health District• for a permit to construct and install the work he described. This application is made in compliance with County Ordinance No. 549. C� SE P JOB ADDRESS AND L CATION--- ,21 �!� b --dam[C _— .- . ��`" "v ------ _`Phone Owner's Name--------- ----- _ "t/1 1_c Address-------------- ,/�- Contractor's Name___-_ ------------------------------------------- Phone_________________________ Installation will serve: Residenc Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I Number of bedrooms Number of baths / Lot sizb � J Water Supply: public system ❑ Community system ❑ IdAek Private Character of soil to a depth of 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-A_P-----Distance from foundation----J�______-Material----- --------------------_________ ----__ -- ----- . No. of compartments________._______Capacity_______t9410_____Size_ _ __ _______Liquid depth_______'~f"______-____ C, ` Cesspool: Distance from nearest well_-__•____________Distance from foundation--------------------Lining material--------------------------__----_____ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from -Foundation--------------------Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Dispo al Field: Distance from.-nearest well---/0_ ____.Distance from foundation..-_ --------Distance to nearest lot line,_ Number of lines__________________ __-___ Length of each line------1_ Width of french------ Type of filter material__,,Af Depth of filter material______ Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------------------- ------- --------------------------------•--------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------- \1 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ AL1 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. (Signed)-...--- -•---------•--- - ----------------------------------------------------------------(Owner and/or Contrac By:.. �'�'�^'`"' "`-� --------------------------------------------------(Title)---------------------------------------------------------------- {Plo+ plans, showing ize 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------------------------ 4 - DATE _ -------------------------------------------------- -- --------------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- •----------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- ----- ---- -- - ----------- --- PERMIT No.3_7 _ _ ISSUED----- --,-- „� (Date) FINAL INSPECTION BY------------- ------------------------------------------ Date —--.--_.------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-21A 9-50 W=1639