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` APPLICATION FOR SANITATION PERMIT 8 q1 (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. r. This apflicaticn is made in compliance with County Ordinance No. 549. � JOB ADDRESS AND LOCATIOiJ.... 3-' .. ..wS7L' �--o n S_g ti , fid r= ��.)rut'_-J.—, .•f mODrr . Owners Neme_...._.. _... ._._../.L• lJ......._L.14-is...i.�........ "._ .. .__.... .......... Phone....... ........._...... r Address...............------...........---•--._.lf......4vt0.�--......................................_._.__........ - .......................................................................... Contractor's Name............__..................p..�.Y..E.P...: _ . ...--------------------- - ----- Phone................- ................ . ............. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ r � 5C Z(o Number of living units: ❑ Number of bedrooms a- Number of baths �f Lot size........'�..........................�--------------... Wafer Supply: Public system ❑ Community system ❑ PrivateXhm - Character of will to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ AdobeAr Hardpan❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200feet.J r So }ic ank: Distance from nearest well.�.r...-.Distance from foundation.....10� Material No, of compartments.......... c..........capacity...Aqcp........Size...yj4. S .L.qd.e..-p.`t.-h..`...........u.....V.........r_._...... Cesspool: Distance from nearest well.................Distance from foundation............._.... Lining material------------............... ._.... ❑ Size: Diameter.....................................Depth.................................................... -Privy: Distance from noorest well.................. ..............................Distance from nearest building................................ ._._... ❑ Distance to nearest lot line................................................ Seepage Pit: Distance to nearest well........_............Distance from foundation--------. --------.Distance to nearest lot line-............... r. ❑ Number of pits.....................Lining material.......................Size: Diameter......_................Depth................................. t / r Dispospl Field: Distance from nearest well.........CIs,aPcgSrgm foundation----/4...._.._Distance to nearest lot line..... . 3ZI '' -a g"�`{" ?-? 'r.4L-Width of trench......... �� r //"\\ Number of lines---------`''---.��....p.-��.L�ent o marc.------/........ ............... Type of filter material......4 .�JtDepth of filter material._..../.�..�.....-. r Remodeling and/or repairing (describe):.............................------------------------...............................................................-....._.._.................. . .._........_...._......-...._........................_......_...._...............,...'..........-........................................................................................_.._................ .. r I herebyy certify that I have prepared this application and that the work will be done in accordance with San Joaquin County odinances, State laws, and rules and regulations of the San Joaouin Local Health District. (Signed) _-..._... .......� . .._._. .. .__.. .....(Owner and/or Conkector) (Plot plans, showing size o�location of system in relation to walk, buildings, etc., must be filed with Ws application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-._....... ....... .. _. ._ . DATE..._.... REVIEWED BY............................. ... ... - .. _.__ . -_. .... DATE _ . .... ....- ... ......... BUILDING PERMIT ISSUED............................................. ..... ....... . _. DATE........_. Alterations and/or recommendations:..............___.._....__. _. ._ _.. _ ._ ...._. ..._........._----------------: y ........................................................................................-............... . .....__._._ -..___.._................_ .......... . ........... . .............. . . . ...................... ....... . ............ .. ....................... ......... . . ......:.... ... ...-..... _..__. . _ . .......... . _.. �... ........... PERMIT No...8. r.. ISSUED.. ..1.�/S ___ (Date) FINAL INSPECTION BY Datc /n - r' r'^' . L SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Socth American Street Stockton, California ES-9--2M 9-50 W-1639 L L