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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) N Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. „ This application is made in compliance with County Ordinance No. 549. 54 9. JOB ADDRESS AND LOCATON-_____ �__�_9 3 _ _ --_,----- - - ------------------------------------- --------------------------------------------- Owner's Name------------- � 7 """ 0------- 4_S4------------------------------------------------------------ Phone-----Address•------- � a------S-P--1' ------------• a__ f ` Contractor's Name_____ ----------------------------------------------------------------------------------------------- --- ----- -- - ___________ Installation will serve: ResidenceiPhone----------------------------------- \ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [7] Number of bedrooms D- Number of baths ❑ hot size_____fP ___SS-_____ � Water Supply: Public system v Community system ❑ Private L] Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ^ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellpistance from oandafiion__ " _ �� j _, Maternal - --=------=--------- =-------- �, No. of compartments___- ___ Ca acit � _ Size____ .____ �� - p Y -- -------Liquid depfh---------- ---- ---- - Cesspool: Distance from nearest well_________________ E71 Size: DiameterDistance from foundation________-_________ Lining material_____ _+" -------------------- Privy: Distance from nearest wel)------------------------------------ ._____"""__.Distance from nearest'building "1 Seepage Pit: Distance to nearest well______________________Distance from foundation____ w _ ______________.Distance to nearest lot line------------ ❑ a Number of pits----------_____-------Lining material----------------------- Size: Diameter Depth------------------ --------------- Disposal Field: Distance from nearest weiL___ O Distance from foundation---lO------------Distance to nearest lot line---3—of lines-------------�+,__i--"_-_-------Length of each line___-_____Je ----------------------- R --- r Width of french Type of filter material--_�_�--__-h14Depth of filter material �_ 4r " Remodeling and or repairing / p g ------ -------- ------ --------------------------------------------- - ------------------------------------- - -------------------------- I hereby certify that I have prepared this application and }hat the work will be done in accordance wifh San Joaquin County ordinances, Sfa!plaws, and rules and' regulations of +he.San Joaquin Local Health District. (Signed)____ --------.---------------------------------------------------------------(Owner and/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______- __"_jf"__ DATE ------- REVIEWED BY------------------------------------------- v��---�-J----- ------------- -- ---------------------------------------------------------------- DATE_ ---------------------- BUILDING - PERMIT ISSUED ------ - -------------"__"-- ----------------------------------------------------------- ---------- DATE-------------------------- - Alterafions and/or recommends+ions:_________________"_______ "�""------ ------- - ---------------------------------------- - ---------------------------------- ------------ ------- - -------------------------------- ---------------------------------------- --------------- PERMIT -- ) BY: V l -"" " Date FINAL INSPECTION Date ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California r