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APPLICATION FOR SANITATION PERMIT 2 (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___-- -6;- ��------- - - ---- 1F3Gi_1!'/ _.__.fl --Y ------------------------------------------------- Owner's Name-------vv__i---61-------- '/� / L------------------------------------------------------------------------------ Phonet�-"- `��1 Address ' - --- ----- ------------- Contractor's Name--- � i ' 1 � �-11� � U � /1�-- Phone-__" i . Installation will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court. ❑ Motel ❑ Other ❑ Number of living units: lb Number of bedrooms Z Number of baths 14 Lot size----/,-. - s -------•-------------- Water Supply: Public system ❑ Community system ❑ PrivateX Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q - Septic Tank: Distance from nearest well_,�e1.--__._Distance from foundation---- _�� Material__ ' ---131{ ANo. of compartments____�_________________Capacity ___Liquid depth__ '�`___-__ Cesspool: Distance from nearest well-----------------Distance from foundation___.-___--._-_____.Lining material.-__._____-.____-_--__--__--------- - ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well------------------------------------------------- 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 neares well ff1____._.Distance from foundat on-_ .0---_____Distance to nearest lot line_.;0__._ Number of lines----- :__ t� ength of each line.-,�-�_-----------_ Width of trench__. -�t_��____._______.... Type of filter material-_! _. �___ Depth of filter materiaL.___ /------.__ Remodeling ,and/or repairing _____ -_.___ __-__ t__ __.,_f F`_l:" -___---�C.1 C ---. ---------------- - --------- f �- .------------------------------------------- = ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 Sp-gulations of the San Joaquin Local Health District. (Signed)--------�- -- f ; < f l------- ---- ----4lX JI ------k-/ '—C (Owner a /or Contractor) v .fir By:------------ �i� e�---------(--- ------ --��-✓'�1' - --- i� (Title) - � (Plot plans, showing size of lot, location of system in elation to wells, buildings, etc., must be filed1with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-— -- - --- -------------------------------------------------------------------------- DATE----------- ------ --------- REVIEWED BY ----- ------ ----- ------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------- ------------------- Alterations and/or recommendations: - A-A------------------------------------- ------ ------I----------------- ----- - ------------------------ ------------------------------ - _ -- f -------- 3 ---------------------------- f ------- - * ------- � --- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- i PERMIT No. = ISSUED =1 ----"--- --------(Date) FINAL INSPECTION BY:---------- z *� Date- '- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639