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— APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Heaifh 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- `-__--_-t Owner's Name_ - -- -- - ------------------- -- - ------ - -----------------------------------------------I-------------- _- ----------------- _-____ --- ----- Phone dress - -------- -------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name__________ " �Iparlm.,��f --------------------------- -- ------- ----------------------- Phone--------------------------------- -- - - ----------------- nstallation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ " "' Number of living units: [] Number of bedrooms [] Number of baths L� Lot size------------:?-Q__�__J4: Water Supply: Public system ❑ Community system [-] Private �'" i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam (] Clay Loam ❑ Clay ❑ Adobe ardpan TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tgnk Distance from nearest well_________________Distance from foundation--------------------Ma terialNo. of compartments----- -------------------Capacity---------- - S ----- ze-----------------------------._Liquid depth------------------------- Cesspool: Distance from nearest well_______________ Distance from foundation-------------------"Lining material.__________-________ ❑ Size: Diameter--------------------------------------Depth------------------- -------------------------------- Privy: Distance from nearest well _______ -------- from nearest buildin ❑ Distance to nearest lot line_---------------- g Seepage Pit: Distance to nearest well______________________Distance from foundation-------------------- ❑ Number of Pits----------------------Linin g material___-___-____"___ Diameter. Distance to nearest lot line__-______________ _ r Size: Diamet`------------------------Depth----------------------------`--- Disposa Field: Distance from nearest well -__-___.Distance from foundation____- --------Distance to nearest lot line-- Number of lines____ - ngth of each line---------- -- Type of filter mate'al_-- --- -- ( f Q �- Width of trench---__"- t epth of filter material_____ Remodeling and/or repairing (describe}____________ _ ' ----------------------- ----------------- ---------------------- --------- L ------- --------------------------------------- ----------------------------------- ---------------------------"---- ----------------•--- 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 Contractor) (PlotBy:. 4 --------•------------------------------------------------------------------(Title)_'------------------------------------------------------------- plans, showing size of lot, locafion of system in relation to wells, buildings, etc., must be filed with this application). E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -e=-REVIEWED BY--- __ ------------------------------------------------------------ DATE---------- DATE --- -------------- UILDING PERMIT ISSUED-------=-----------� -------------------------------------- _ ------------------------ Alterations and/or recommendations:___--�________----___-_-__ ----------------------------------------- DATE------------------------------ - ---------------------- - --- --------------------- --------------------------------------- ------------------------- --------------------- --------------------------------- --------------------•------------- ------------- PERMIT No.-- ` - ISSUED -- ---►-------------(Date) FINAL INSPECTION BY: Date. - E SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California