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A PLI TION FOR SANITATION PERMIT [Complete in Duplicate] Application is hereby made to the San Joaquin Local Health District for a permit to construct an insta the A here d;X*11 This application is made in compliance with County Ordinance . 549. / JOB ADDRESS AND LOCATION_________________ Owner's Name 1�.- ----------- '. - -`-------------------- Phone Address--...---------------- _o-------------- -- -- A------------------------------ Contractor`s Name---------------------- ----- ------------------------------------------------------------- Phone- - •---- - - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [ ] Number of bedrooms Number of baths 9, 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 �ardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS �/� �. f ►t:; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 0�o p on____ / a tt-- f0_t_.Material ------- - - -I` ` Se tic ank: Distance from nearest well_ _�"�___Distance from foundation No. of compartments__------ -----------Ca aci ___" �Ok� ± it - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______________ --- Size: Diameter--------------------------------------Depth---------------------------------------- _ ----------- - Privy: Distance from nearest well____________________________ '". �'� Distance from nearest building----------------------------- ------ ❑ Distance to,nearesf lot line----------------_- __ , - --_�-_�---;�--------.------ Seepage Pit: Distance too nearest well----------------------Distance from foundation-------.-----------Distance to nearest lot fine_______-_______._ ❑ Number of pits---------------- - -Lining material---------------------- Size: Diameter ----------------.Depth--------------------------------- �Dis os ('Field: Distance from nearest e11>_0.1__Distance from foundat'o - tante to nearest lot fin 10-- Number of lines------ _- --� ______ __Length of each line___ � � � _ id+h of french_--_____ - ------------------ Type of filter material____ ._ -�.(-Depth of filter material-------1-2-ri----- 0W •�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)--------- 5 3 --------------------------------------------------------------------------------- Owner and/or Contractor) By: --------- ----------------------------------------- - Tale (Pl --- ot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application]. FOR DEPARTMENT USE ONLY ti APPLICATION ACCEPTED BY---------------- ------------ DATE---------��--- --- �'a REVIEWEDBY----------------------------------------- --- --- - ----------------------- ---------------------------------------- DATE ---------------- UILDING PERMIT ISSUED------------------------------- ----.. DATE----------------------- - --------------------------------------------- ----------- Alterations and/or recommendations_________________________________ ___ --•-----•-------------- /+,r/ -mac ,.. �� ' f Fes! --- ---- _ - -.." r _ — --------- -- ------------_- -- -- ------------------------------------------------------------- ----------------------------------------- PERMIT No___ _ ISSUED-- --� - Date) FINAL INSPECTION BY:_._. 1 - ---r-- --i---- ;- _ Date--=-------- - SAN ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-4-2M 9-50 W-1631?