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f' APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) �y . rST. s 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. 1 _ _ _ "' 1p------ JOB ADDRESS AND LOCATION____ .I. -' 3 --r- -- -'- } -----F-1,6----- �� -- -- -------- ----------- -- ---- Phone------------------------------------ Owner's __------------------------------ Owner's Name----------+ ----------- 1 ,t Address--------------------- ---------- ------- ---- - -------- ------ - -- ---------------------------------------------------------------- --- Phone---------------------------------- Contractor's Name---•----------------------- ------------------------- ------ - Installation will serve: Residence ®. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 5 x ---------------------------- Number of living units: 1� Number of bedrooms �] Number of baths 0 Lot size_________ ______ '.__ Water Supply: Public system E� Community system ❑ Private E]Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam ElClay ❑ Adobe J Hardpan F1 TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 2DD feet.) ( l P t ,pa�-d d -------.MatrriaL ,/� Septic Tank: Distance from nearest well___�t�Y__---Distance from foundation__--_� - �-- ---`-�-� d-d Size �y�3/,�--------Liquid depth Z.. QNo. of compartments_--______�----------Capacity___--------------- l� I ______________Distance from foundation--________--_______.Lining material_____________________-------------------------------------- Cesspool: Distance from nearest well__ Size: Diameter----------------------------------------Depth----------------- --------- ------------- ---------- El Ch -----------------------Distance from nearest building----------------------------------------- l :Privy: Distance from nearest well__________________________ 4 ❑ Distance to nearest lot line----------------------------------------------- 1 Seepage Pit: Distance to nearest well----------------------Distance from foundation_________________-Distance to nearest lot line----------------- ❑ -_-----------__-----Size: Diameter----------------- ----.Depth--------------------------------- Number of pits----------------------Lining material--- Disposal Field: Distance from nearest well___ Distance from foundation_________--Distance to nearest lot line-----'�_�___. (� Number of lines__________ -- Length of each 1i Width of trench-___2:- ------------------------ Type of filter material_ _. Depth of filter material______;f -�------- J Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------•------•------------------- -----------------------------------------------------------------------•-----------------------------------•--------J q ------_u_ ou y I hereby certify that I have prepared this application and that the work will be done in accordance with San oaquin nt ordinances, State laws, and r sand regulations of the San Joaquin Local Health District. b- ---------- --------- ---------- ---------- -----(Owner and/or Contras - ----- --------- I, ----- -(Tit e�-- ----------- ----------- ---------•------------------------- Y= ----- -------- --- - - ------------------ ----------------------- (Plot plans, sh g size of lot, ca ion o Sys min elation to wells, buildings, etc., must be filed with this application). l FOR-DEPART ENT VSE ONLY ( APPLICATION ACCEPTED BY - - ----------------- DATE f --------- - DATE----------------=-------------- ------------------------- REVIEWEDBY_-----------•---------------------------------------------------------------------------------------------- --- tBUILDING PERMIT ISSUED---------------------------- - --------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-------------------------------------------------- -------------------------------------- -------------- - - ------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- r� ---- --------------------------------- PERMIT Nc -Q _ Y-- ISSUED O Y/` ---------(Date] FINAL INSPECTION BY___________ ____ _ •.--- t7-- Date 6 SAN JOAQUIN LOCAL HEALTH DISTRICT m 130 South American Street Stockton, California r ES-9=2M-9-50.W=46T? _ k