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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. t This application is made in compliance with County Ordinance No, 549. U_ _ �J'+� = -•----•--------------------- ----------------------------------------------- JOB - ---- ----------------------------------- JOB ADDRESS AND LOCATION----------------�-Pt 90----- Phone-__,2_4.65 ------- Owner's Name------------------------- = - ----------------------------------------- ------------------------- ------------------ ------------------------ ------------------------------------------ Address.-------- --•------------------------ E' ---------------------------- - Contractor's Name-------------------------•------------•--------•------------------- --------------------------------- ------ --- ------- Trailer Court ❑ Motel ❑ Others❑ � Installation will serve: Residence,V Apartment House ❑ Commercial ❑ _. Number of living units: F1Number of'bedrooms Q Number of baths m Lot size______�•__ ______X--TA / _•-s _` _____ f Water Supply: Public system ❑ Community system ❑ Private ❑ an Adobe Hard Sand Gravel ❑ Sandy Loam ElClay Loam ❑ Clay ❑� � p O Character of soil to a depth of 3,feet: San ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest Distance from foundation________ ---.Material----- No. of compartments ' Capacity_. QD------Size---•--9 _ Ligwd depth = Cesspool: Distance from nearest well-----------------Distance from -foundation--------------------Lining material------------------------------------- 171 ___--_________-_________-__❑ Size: Diameter-------------------- --------------Dept --------------------- -------- --------- - ------- __________________Distance from nearest buildin ------------ Privy: Distance from nearest well---------------------------- - g__�------ -------- �--�-----� ' ❑ 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: Diamet�------------------------Depth----------------------5----- f6_____,-_Distance to nearest lot line________.__._ Disposal Field: Distance from nearest well_-__I��-_____.Distance from foundation___ y Number of lines___________ __--------------Length of each line____Ga-�, o_--�a--_.Width of trench-------- - ------------------- Type of filter material------1-�s..-M�--Depth of filter.mater�al_________� _ ___-- 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, d rulesjand regulations f the San Joaquin Local Health District. ---- ----------- --------------------------------(Owner and/or Contractor) (Signed)--------------- l�itle)-------------------------------------• ------------------------- By:------------------- ------------------------------ ------------------------------------------------------------ (Plot plans, showin size of lot, location of system in relation to wells, buildings, et must be filed with this application). FOR DEPARTMENT USE ONLY DATE----- ---.�' �-�-- ------------ APPLCATION ---------- APPUCAT[ON ACCEPTED BY------------------- ------------------------------------- ---------------------------------------------- DATE------------- ------------ ---------/-----------•----- BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------- -------------- DATE------------------------------------------------------------- Alterations and/or recommendations:--------------------- ------ ------------------- ••_- - CT ------------------------------- - PERMIT No.----1cs`0 -------- ISSUED----D'-'-�'3.`5�1------------(Date) FINAL INSPECTION BY:------___ ------ - -------------- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639 �"