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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 insta4l the work herein described. This application-is made in compliance with Courfy Ordinance No. 549. JOB ADDRESS AND LOCATION -7 r Owner'sName -�`Q _ . - - t---- ----- ---- ------------- ---------------------- ---------------------------------- -------- Ph6ne---c;-_3-77-j-�,9------- Address------------- -o>r------- = ----------------------------------------------------------------------------------------------------------------------------- Contractor's Name-------------------------------------------------------- ------------------------------------------------------------------------- Phone------=--------------------------- : Installation will serve: Residence Z] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [Z] Number of bedrooms Q. Number of baths X Lot size__ -------------------------------------------------- Wafer "_�_�__�_:6__3- -------- _____________ Water Supply: Public system ❑ Community system ❑ Private 0-01" 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_____?©___Distance from foundation----10---------Material------ '' z_____________ __________ [� f r� No. of compartments--------.___2--------Capacity-------R�Pt_p---Size-------.-"-'�3.X..?-___Liquid depth_ ---------- - Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_c_________________________---_____ Size: Diameter--------•-------------------------_-De th--------------------- -- Priv 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 pits----------------------Lining material-----------------------Size: Diameter.........---------------Depth---------------------------____-- Disposal Field: Distance from nearest welL_- ----.-Distance from foundation_____ _ "_______Distance to nearest lot line----_$___........ LvJ Number of lines______...___e'Z--------------------Length of each line---------&P__ -'---.Width of french-----------"Z 0__`'______________f. Type of filter material___ » ______Depth of filter materiaL________� ��__:___ Remodeling and/or repairing (describe) ----------------------------------------------------------------------------------------------------------------------------------------- ----------•--------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- - hereby certify tha I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, a d rules and r ulati s f the San Joaquin Local Health District. • Si ned •----- �E1 -------------------- --------------------(Owner and/or Contractor) By: ---------------- --- -- Title (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----------------------------- -- -- --- ---------- ----------------------------- DATES £SZl ---------------------- REVIEWED BY------------------------------------- --- ----- ----------------- DATE �_�_` `.mac - - BUILDING PERMIT ISSUED----------- --O _ ---- _ t_ 1_�'-_ --- �- DATE------l- r �`` Alterations and/or recommendations:--------------------------------------------------------------- ------------------------------------------------------------------------------- ------ •---------------------------------------- PERMIT No-------/_'7/------- ISSUED----- ?----- -Y_�_5 ---(Date) FINAL INSPECTION BY:---------------------------C_ Date------------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT - 130 South American Street Stockton, California ES---9-2M 9-50 W-1639 ..