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APPLICATION FOR SANITATION PERMIT 46 ( 7 (Complete �n Duplicate] Application is hereby made to the San Joaquin Local Health District for a permit to cons+ruct and install the work herein described. This application is made in compliance with Count rdinance No. 549. JOB ADDRESS LOCATION_-__ _ __-- -------------------------- --- - ---- -- --- ------ ------- ------ --------�- -- -------- ------- --------------- ------- -- Phone Address------ = ________________ _______________ ------- Contractor's ame------ ------------------------ ------------------------------------------------------------------------------------------------------------------------------------- Installation will serve: Residence Phone_________________ ------------- Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot I ❑ Other ❑ Number of living units: [jf umber of bedrooms ® Number of baths m Lot size----- �-_---_X----��Qf' Water Supply: Public system Y Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 1L11 �Iardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well---a�NS-0r----Distance from foundation-------_/_ ___--___. No. of compartments_-___-___-til-----------Ca acit _p Material____44—v,_ -- -- ------------- Cesspool: ------------ Cess o01: Capacity 2pf#-Size 9x_Y-X-�---------Liquid depth------r`/� P Distance from nearest /-,,------------- est from foundation--------------------Lining material___-_____-_---------_ ____ r ❑ Size: Diameter----------- '--------- ------Depth-------------- ------- Privy: ---------- Y: Distance from nearest well_____________________ ❑ Distance to nearest lot line ---------------Distance from nearest building----------------------- - ____ _____________ I. 'Seepage Pit: Distance to nearest well----------------------Distance from foundation _________ ❑ Number of pits______________________Lining materral----------------------- -------Distance to nearest lot line__- Size: Diameter-----------------------.Depth--------------------------------- Number ------------ - - Disposal Field: Distance from nearest well____ D�----.Distance from foundation-------3 '_---__-Distance to nearest lot line__--�'0______ Number of lines__________.__��__►___- -_ - ---------Length of each line----- --�©_,L--------Width of trench-----------.?-.y'� Type of filter material_05^ __k-o�A __Depth of fill er materiai______J "---__-_ r _ Remodel nng aor repairing (desc e),. ----------- - -------------- ---- - - ----- --� ------ __ ---------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa uin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. qty BY: ---------- -------- ----------- Owner and/ ----- --------------�----- ----- ---[ actor] --- ----------------- - -- ----------- - (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must beefiled with this application). FOR DEPARTMENT USE ONLY — APPLICATION ACCEPTED BY--------------- DA��^" j REVIEWED BY------------------------------------------- - BUILDING PERMIT ISSUED comme-- ti ---- - ------------ --------------------------------------- DATE-------- -------------------------------------------------- ------------ DA ------- --------------- ----------------------- Alterations and/or recommendations_________________________-- ---------------- - - - ------------------------------ -------- - - - ------------------ PERMIT No __-- ----- ---- ISSUED------------ -----� ---, - -------(Date) FINAL INSPECTION BY:---- ------ ----------------------------- Date 6 -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES--9-2M 9-50 W-1639 Stockton, California