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ArrLICATION FOR SANITATION PERI.., (pi (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and 1 1 e A herein described. This application is made in compliance with County Ordinance No. 549. O JOBADDRESS AND LOCATION............................................................................................................................ -- -------------------- Owner's Name----------------------------------- ---- Phone f Address Contractor's Name--------------------------------=------"----------------------------------------------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial E] Trailer•Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms ❑ Number of baths Lot"size........_-----'__________.____ ____________________________.__ 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 ❑ CS 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.................Distance from foundation.__.__ Material--------------------------------------------------` .------Size--Z,' .�-----�-- -•----Liquid de - -•--/------------- Q No. of compartments_.__._.__'_______________Capacity____ `..:_= ! �' depth q p Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material________.._____•_-._----_____________- , ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 1-1 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 nearest well....::..........Distance from foundation....................Distance to nearest lot line..- ____________ Number of lines-------.................. — Length of each line.....��C�______......._.Width of trench__ ,}�r _�::: ....... Type of filter material. !',/____Depth of filter material_4_-0 .-_._____ 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. — J J (Signed) . .t - =dt---- --------- =r% ---------(Owner and/or Contractor) By:................rr ---------------------------------------------------------(Title) t•� �, ' (Plot plans, showing size ofy ot, location of system in relation to wells, buildings, etc., must be filed with this applip cadn'). FOR DEPARTMENT USE ONLY // APPLICATION ACCEPTED BY REVIEWEDBY -------------------1�--� r/ --------------------------------------------------------- DATE......... BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- -•--•-•---------•---•••----•--•--------•------------------•--•-•---•--•---------•-•---------------•-••------•••--••--••---•--•----•-•----••-•••-•-••-••-•-•-••-••--•--------------------------------------------------------- •--•-----------••-•---•--•-••••-••--•-••----------------------•----•-••---•-----...••-•---------•--••••------•----•-•-•-------------------•••----••--•--•••••••••-•--------•-•--------------------------------••-•--------•-•- 14 PERMIT No. .I--- ----- ISSUED.._-_s-3'' ___ `S- (Date) FINAL INSPECTION BY_____________ __ _ ---------------------- Date---------------------------- --- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639