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w r F APPLICATION FOR SANITATION PERMIT �- (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permitto construct and install fh wok her in die ribec). This application is made in compliance with.County Ord'n nce No�,54 ' IN« 0l- o ", 4.i,_ �" e °� . D JOB ADDRESS AND LOCATION... ----=�-------------------------- __ ----------- ;------------ Owner's Name N-. ----- - -------------- - --- --- -------------- Phone-- I ---------------- 1 Address---------�-M-� } --- lam' ------ - -------------- ---- --------•---- -- f i ' - Contractors Name---------------- --� -,!!' ,N�.=---------------------------------------------------- -------------------- Phone--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mro��fel�❑ yOther ❑ ` 1 Number of living units: [r Number of bedrooms [2. Number of baths -E-Bt-L# Lot size________�":` ___/.__�!_____ .-- _ -- Water Supply: Public system ❑ Community system ❑ Private r Character of-soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam g Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee/t.) ,..•,.,...__Septic Tank: Distance from nearest w.elE__�j_ ___-___Distance fro oundation__Y_f.0�___ Material__:_.__.____,___ ____________ _ �. --Size --- --- � ---Liquid de th - ----- ------- ! No. of compartments------------o ±---------Capacity------- ----- ----- --- - p l Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------___ _______. ❑ Size: Diameter--------------------------------------Depth-------------------------------------- ----- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------- Y________. ❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance tonearest well----------------------Distance from foundation-------------LLL__-..Distance to nearest lot line_________________ ❑ Number of pits--------------- ------Lining material-----------------------Size: Diameter..........----------------Depth--------------------------------- Disposal-Field: Distance from nearest well___ __ __.Distance..from foundation------ -- to nearest lot-line___ ___- , Number of lines___________ / _____-__`-_--__Length of each line------- ___!/__.Width of french--------A- P IV `--- Type of filter material'-JA10 _�_ �Depth of filter material_______ _ Remodeling and/or repairing (describe)=--------------MU ------A& ----- --•-••---------------•------------------------------------- --..•_..------------------------------------------------------------------------------------------------------------•---------------------------------- ----------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------------------- r 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 o the San Joaquin Local Health District. L (Signed)--- ---------------------------------------- Owner and,Contract By:------------------------------------------------------------------------------------------------------------------------------------(Title)---.----------------------------------------------------------- (Plot plans, showing size of lot, locafion,of system in relation to wells, buildings, etc., must be filed with this application). : ' FOR DEPARTMENT USE ONLY ----------------------- DATE----- ----�-------------------- APPLICATION ACCEPTED BY----- --------------------- -- --- -------------------- - � - BY - DATE --- REVIEWEDr 7. BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------I--------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations--------------------------------------------------------•------------------------------------------------------------------------------------------------------ ------------------------------------:------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- --------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------- ------------- ------ PEkM1T No.__L_'_3_ ---- ISSUED-- �\ J� �1-------------- Date) FINAL INSPECTION BY: ------ : ..._ _ j 1�1 Date------------ r { ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M9-50 W=1639 ;