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i� 2 APPLICATION FOR SANITATION PERMIT (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---------- --- `,�2----- - , -- ---- -- Owner's Name / - -------------- C Phone . 17-1 l -�1 Address---------- -3--f� � ---------------------------------------------------------------•--------------------------- Contractor's Name------- ------ ------------------------------------ -------------------------------------- Phone �_'_7__9 Q__,��.------- Installation'will serve: Residence D9 Apartment House El Commercial [] Trailer Court E] Motel ❑ Other E]Number of living units: ® Number of bedrooms EU Number of baths Q] Lot size------ ©_____._ __f___ _�-----------------------` Water Supply: Public system ® Community system ❑ Private El Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam E] Clay E] Adobe® Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sepfic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_________--------_____-__________--_-___---__ . El No. of compartments--------------------------Ca __Size--------------------------------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---------------------- from foundation____) -------Distance to nearest [of line -7-------- Number of pits-----------I--------Lining material__n_(1__C_k,___Size: Diameter___.,3_A&...__........Depth ____________ :Disposal Field:. Distance from nearest wel _________________Distance from foundation___,.___-0------Distance to nearest lot line___�_�_____ ® Number of lines______________g__------------.----Length of each line-__-----�_U--------------Width of french--------a- -----__-___----____ Type of filter material____ Depth of filter material............ Remodeling and/or repairing (describe):----------A�_ 1 `"i` •�-�'4�P�--------------------------------------------------------------------- ---•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•--------------------------------- ---------------------------------------=-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 dregulations of the San Joaquin Local Health District.- _________________Owner and/or Contractor) By: --------------------------------------------------------(Title)------- � ,-------------- (Plot plans, showing size ofAo�Iocatef/s tem in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- _:-' DATE--------I----- -- -----------5-�-------------- REVIEWEDBY-----------------------------------W. -------------- - --------------------------- ----------------------- DATE------ -------------- BUILDINGPERMIT ISSUED---- --------------------------= -------------------- DATE----------------------------------------------------- - - � ' 4 /� "�Alterations.and/or reco men4ations: -----Le— ----- --- -n-------O V _f-1 -P 1G- - '" ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- ------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- 104 PERMIT No./_Z Date--------------------- I -- - - --' --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639 i.