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APPLICATION FOR SANITATION PERMIT s ;1 (Complete in Duplicate) f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein This application is made in compliance with County Ordinance No. 549. described. �Cl 2-3 nJ • ([.!>2Er1`f L.v '. pp } r s.. r JOB ADDRESS AND LOCATION___!3•_'_gz, 1/3 Owner's Name - --------------------------------- ----- ------ -- -- -------- ----------------------------------------------- ------ Phone/Address c -------------------------------- - ---------------------- -----------------------------•--•------------------------------------------------------------------------ Contractor's Name-.--- t p Phone- Installation 4 /7------ Installation will serve: Residence's Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ N Number of living units: t Number of bedrooms� Number of baths Lot size___-�� Q- �( ---0--------------- Water Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe V Hardpan ❑ TYPE OF INSTALLATION AND SPECIFlCATlONS: R e (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---40_.---Distance from foundation_____ ~ ��-_-__--Material--- - --------- - --- No. of compartments ------------------ p �----------CepacitY---�(!4_ Size-i^5��__E-�t"_t�_Liquid depth----��-�� --------- Cesspool: Distance from nearest well_________________Distance from foundation - Lining material____--________-�_________ ___ 171 Size: Diameter_------------------------------------ ------- ---------------------- Depth Privy: Distance from nearest well-------------------------------------------------- Distance from nearest buildingri Distance to nearest lot line____________________ c� ---------------------------- Seep e Pit: Distance to nearest well__-----�s R / ___Distance from foundation______ --___.Distance to nearest lot line___v` ------ ---- Number of:pits------__j-______ Lining material___ .---Size: Diameter___%73" Disposal Field: Distance from nearest well____ �r _____________Depth___ Q_--_-------___ _ ____Distance from foundation____f ------"Distance to nearest lot line_-__• _�___ Number of :lines------------ -------------- ----Length of each line-----'- - - g � ---------------Width of french_------��-�----- ---- Type of fitter material -_ ______Depth of filter material----I>_��--__--_ 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 es and regulations of the San Joaquin Local Health District. (Signed)----�: ,� ------ a�---..�_ - - --- --•--------- -------- -------� ------------------------------------------ By: ------- �/or Contractor) ------- --------(Title)-- ___________ -- ---------------- -------------------------------------- ----- ________ (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-----W.REVIEWED BY -----U _ - DATE----- --- ��-2__''-� ____ )-------------------- -------- -- DATE---- r" ------- BUILDING PERMIT ISSUED----- ----------- ---------- - - ---- -------- -------- -----�------- ------ ---------------------- ---------------- DATE Alterations and/or recommendations_ '- -------------------------------- ---- --------------------------------- - -- ------ PERMIT No-------- - ---------- ISSUED----- ' Sa (Date) FINAL�,JNSPECTION BY:--------"V ---------------------- Date----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California