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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 the work herein described. This application,is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------------------- g_25 I '`�t ?--'` GIs Q------------------------------ Owner's Name--------------------------------------------------- ------44-77 X?-------- - ------------------------------------------ Phone------------------------------------ Address Contractor's Name--------------------------------------mo i'f-1 + "l Son T_;-- L nc-------------------------- Phone----, '7� d Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ] Number of bedrooms p Number of baths [ZI Lot size------ ......?_4-------------------------- Wafer --- -------------------Water Supply: Public system ® Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic tank or cesspool permitted if public sewer is available within 200 feet.) n Septic Tank: Distance from nearest well_ QIti?____Distance from foundation----- C>___'_------Material--- l7`c. ® No. of compartments_________ ------------Capacity----Q'4-0-Cr------Size _� �_r -6-Liquid depth---_� --"--_-----. Cesspool: Distance from nearest well_________________Distance from foundation----------------------Lining material------------------------------------- El -----------_------___------____-_ __❑ Size: Diameter--------------------------------------Depth--------------------- ----------------------------- -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 pits--------------------- Luning material-----------------------Size: Diameter------------------------Dept h--------------------------------- Disposal Field: Distance from nearest well_Aornue-__Distance from foundation _---___Distance to nearest lot line-�__-______ Number of lines--------l-------------_---- ___Len Length of each line----____ " g ` ..-- Width of trench ----.2-�� Type of filter material-__-)-- _"�_---- _-Depth of filter material__-------�_g i Remodeling and/or repairing (describe)-------- ---------------t------- -------------------- ---------------------------------- y --- � `�' �. -��t �_�r-� o� ---------------------=------------------------------------- - -----------------------------------------------------------------------------------------------------------1----------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed)--- xL_G,,K#__ +aVA_5----- : -- ------------------------------------------ ----------------;---f A ontractorJ By:---------- ---- ------ (Plot ---(Plot plans, show g size of lot, location ofysystem in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- DATE____--------- __-- REVIEWED BY------------------------------------------- 9, ----------- - ------------- ---------------------------------------- DATE-----------q-------------------------- 5---------------- UlLDlNG PERMIT ISSUED -------------------------------------------------------------- DATE Alterations and/or recommendations-----------------_--- --__-------__-__-_-----------__ --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------•---------------------- ----------------------/--------------------------------------- PERMIT ... ISSUED--- - -- -�___-(Date) FINAL INSPECTION BY:_- - ------------- Date_---------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street E5-9-2M 9-50 W-1634 Stockton, California