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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 3fv(o ,��ice �" i� © 11?s azo--o j pplication`is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_____?f_ B ? n �� ---- ---max---=-------Q_N--_��r4�'±�-t�_._,,�� +�1�----rrJ_�1V Owner's Name-----L;; --------- - _V - Phone ff-------------------- Address----•------ P-0 --------------------- -- ---------------------------------------------------------------------------- Contractor's Name-------------) D--- ------Fp --------- -------------- --------- Phone w Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ISIN Number of living units-. Q] Number of bedrooms 09' Number of baths [a Lot Water Supply: Public system ❑ Community system ❑ Private N I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0. 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----XV-0----Distance from foundation------I-4_`-------Material--------- !9-&_A(-*4 No. of compartments---------I-------------Capacity---)--'�4 --------Size-------------------------------Liquid depth---------4- - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__________-__--_________ Size: Diameter---•--------------------------------Depth-------------- ----------------------------------- Privy: Distance from nearest well--------------------------------------------------Distance-from nearest buildin ❑ Distance to nearest lot line------------------------------------- r / ! Seepage Pit: Distance to nearest well___.__r DQ_______Distance from foundation__-_-_-------.Distance .to nearest lot line_-__10_______ A Number of pits------I--------------Lining material A°t_?M ize: Diameter________ -�-�--------.Depth------X-0-------------- ----- Disposal Field: Distance from nearest well___50--____.Distance from foundation-----1Q�---------Distance to nearest lot line_____ /-__•_ Number of lines------------j--------------------Length of each line---------1_�-Q '---------- Width of trench__ -- _y_��-----.---__-__------ Type of filter material_Vh- '-Yds-�`--Depth of filter material----------/c?--------- Remodeling - ---__ Remodelin and ore airing (describe): ___CQ_ s f 1 . 9 p g ( ) N- Q----�_N�f'_TF 1_.1.A• _LQw ------ � !'� '_.r � ------ L��r-A ----------------------u.lj-F--- -- ----- --------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=---------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- - --------------------- ---------------------------------------------------------------- ;(Owner and/or Contractor) $Y� ` -----------------(Title) -r _ _ -: �`------ -------------.------ {Plot plan s owing size of lot, location of sy$ em in relation to wells, buildings, etc., must be tiled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ DATE -___-_____ __� REVIEWED BY I-)-�'---�--J1---- --- ---------------------------------------------------- DATE BUILDING PERMIT ISSUED---------------------------------------------------------------- -------------- ,PATE-- Alterations and/or r commends ions:____ ______ -if 2._ R --- -- ------- ------------- ---------------- � '� - -N-- - --------- +,� � `" `-------- ------------------------------------------------------- ---- ---- % PERMIT Na. ------- ISSUED___ t----- --.3y�------- --(Date) FINAL INSPECTION BY:-------- v Date--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California +�