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... s.g •' , �__----� "ice .�R , rn APPLICATION FOR SANITATION PERMI RMIT (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. k JOB ADDRESS AND LOCATION— ---_-_ . . -------- � -44------------------------------- ----- Owner's Name---•------------`S_ r -- ------------- . � q-------------- Phane-- Address-------------------------------------------------- ----------------------------------------- ------------------------------- ----------------------------------- -------------------------- Contractor's ame___________________ Installation will serve: Residence ) Apartment House ❑ Commercial ❑ Trailer Courfi Phone___________________________• I Number of livin units;. ❑ M°tel ❑ Other ❑ g Number of bedrooms 12_- Number of baths V1 Lot size-------- _111-49 _ __ Water Supply: Public system �] Community system ❑ Private ❑ - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___52�__4_.Distance from foundation___4! ... � Material___- �__c�Cr�c- ------------ ® No, of compartments---------�-----------Capacity ----��Qd_--Size---�.X_�_�:��_�_Liquid depth----`S'______________ -Cesspool: Distance from nearest wel is ante from foundation____ �--Lirsing material________________ ❑ Size: Diameter--------------------------------------Depth------------------------------------------------ - rivY: Distance from nearest wefl------------------------------- ---------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line ----------------------------------------- -------------- g- W Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot ❑ Number of Pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Disposal Field: Distance from nearest well____:5_'p(_,Distance from foundation___eQ-d.....___ I0 Number of lines------------ 3---- -_-____ -Distance tf nearest lot line____ 7 ______. Length of each line__ - ,.ZT_-Width of trench_____ "----------------- Type of fitter material___ i_�+_te_---Depth of filter material__--f `�--_ Remodeling and/or repairing (describe):---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ -- ------ ------------------------------------------------------ --•------------------------------------------------------------------------------------------------------------------------------- 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). ------------------------------------ ------ ------------------------------------------- -- (Owner and/or Contractor) '- -----------------(Title)--------------- ---------------------------------------------- 6 - (Plot plans, showing siz,of/of, location of system in relation tow I, uildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY_______ I r REVIEWED BY �----------------- DATE------- �-? Z - ----------------------------------------------------- BUILDING PERMIT ISSUED DATE ------------------- ------------------------------------------- Alterations and/or recommendations:---------- DATE �- , - ------------------- ��: -4 --- ------------------------------------ --- - �� -= -------------- ---------=- ---------------------------------------------------- PERMIT No._ _o--- _ ISSUED------ � (Date) FINAL INSPECTION BY:__---- � Date----' --------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California