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} APPLICATION- FOR SANITATION PERMIT a6 (Complete in Duplicate) Application is hereby made to the San Joaquin Local Heaith District fpr a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. I JOB ADDRESS AND LOCATION----____--__�� ---------------------------------------------- i . Owners Name----------------��--Address �- __-�- r fi r Q l -------------------------------------------------------------- ----- Phone--------------------------- Contractor's Name------ - --------------•--------------------------------------------------- -- - -- ------- --------------- ------- ------------------------- ------------------------------------ Phone----------------- -------------- - t Installation will serve: Residence Apartmen- House ❑ Commercial ❑ Trailer Court ❑ Mote ElOther El IF Number of living units: [7 Number of bedrooms [L Number of baths 0 Lot size-_--___ Water Supply: Public system ;6 Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan J] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i` Septic Tank: Distance from nearest well_-__--.64)_•Distance from foundation-_---__- ater.i-al -+ -No. of compartments----------- C --------- apacy--_-�¢® SX ---Liquid depth- V/ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- Size:Size: Diameter--------------------------------------Depth-------------------------------- r . Privy: Distance from nearest well------------------_-__--_-__-_---_-__---___-_--_Distance from nearest building - - - - ---------- Distance to nearest lot line------------------ _ *� f t i . .,Seepage Pit- Distance to nearest well--------d__6__ ___Distance from-foundation-_-____ 15C4---- �fce to nearest lot line-�__'f _--__-__ 7F_ Number of pits---------I--_-__--- Lining materI ;_� Si Diameter_-__ -_ Depth- _ ------------ Disposal Field: Distance from nearest weil__-_ d------Distance-from foundation---_--'______----_Distance to nearest lot line_--__�-__�____ xNumber of lines_________________ Length of each line____-__----___--_-__ - �,---------- -_ Width of trench----.7--+�---�R----------- Type of filter material---,�/i---k Depth of fiiter_.material__---e-_ ---- Remodeling and/or repairing (describe)_----------------N-_ --Vy----------------1,NI -. ---------------------------------- ---- certify - that --- -av - - - - -- --------------------------------------------------------------------------- ----------------- I hereby certify +hat f have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St aws, d r s and regulations of the San Joaquin Local Health District. (Signed) ---- r '--, / ----------------------------- ----------- ------------------ `,O ----- wner and/or Contractor) BY --------------------- -/---- -------- -- - -- -----------------------------------------(Title)-------- ------- (Plot plans, showing size of lot, location of system in rela#ion to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------- __ - - - - DATE------ -- REVIEWED BY------------- ��- ------------------------------------------ -------- ----------- --------- - DATE-------r - ------------------------------------- UILDING PERMIT ISSUED-------------------------- - ' --------------------------•------- ----------------------------------- DATE Alterations and/or recommendations________________ �--------- -- ------ -------------- --- - - - - - ------------------------- -------------------------- ------ -------------------- ------- - ------- -- ---------- ------ - - ---- --- QC's-- - `"'--- - -- - - - ---- -------- ---- -- ---------------------- PERMIT No/b_-_�0 ISSUED------ --- -�--- Date FINAL INSPECTION BY______________ -------------- ------------------------- Da to a.!tt - - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California