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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) s H6LT_ PD , Application is hereby made to the San Joaquin Local Health Disi-rict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------//L,_L_77__,;._:_ C° '�f ------------ -------�� F vQ.�------rJ./-/_.�_t/�P/�?` Phone ,�- ----- Owner's Name________ __ — -Address----------------= _Q. . -------Ls-�- -+----------------- -------------- ------ n0_6 ---- D....-,4 Contractor's Name-----------,D. ,4-------/-9-1 ffl--i6# LSfl1�a�► ��• Phone =��-- w Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other C9 -5dNVAZ j � 1 Number of living units: F-1Numberof bedrooms Number of lice iks Lot size__a.0j0_____)(--- -100_i___________________ Water Supply: Public system Community system F1 Private E] �«�T \ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan ❑ `1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r .um'# Septic Tank: Distance from nearest we��lQtl/_E____Distance from.foundation__��__ Material__�A15�r____um's t_�I___________. { No, of compartments___ _ _________________Capacity_fA�o_&A4. Size '�o_-_.��_�_.______Liquid depth _ ______.___ . Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------_-__-__. ❑ Size: Diameter--------------------------------------Depth------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- El _____________________________-___- --❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------.Distance to nearest lot line________________ ❑ Number of pits----------------------Lining material------------------------Size: Diameter------------------------Depth--------------------------------- .Disposal Field: Distance from nearest wellDistance from foundation--- --------------Distance to nearest lot line___ __– - Number of lines-----&Al ------------------Length of each ----------Width of trench--,I//--- Type rench__,I//-_Vii_________________ Type of filter materiall,*---f t&_Depth of filter material---12'!__.___ Q Remodelin and/or repairing (de -ibe) ,G '� / �---------- 491?-------- 1. ------------------- ------- _H-4v,0--k------------- &-U—S�------- ----- --- i _ 1----- -----------------------z ---- -------------------------------------------------------------------------- i ; - --------------------------------------------------------------------------------- 1 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 rut nd regulations of the San Joaquin Local Health District. 1 X�----A---t----- --- --- -- -------------- (Signed) s --0-{- e-�----6ith ---- --Owner aid/ Contractor} B :-_---------------- ----------- ------------- Title-------- -------------- P' y c (Title) (Plot plans, showing size of lot, location of system in relation t ells, buildings, etc., must be flied this application). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- --------------- DATE---------------------------------- '--z---------------- REVIEWEDBY----------•-------------------------------------------- �----------------------------------------------------------- DATE------------- r----------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------ --------------------- DATE------------------------------------------------------------- Alferatio d/or recommendations:- ------------------ r ----- . ----------------- ----- --- r----------- ------ ----- ---- - ------- --- - ------ - ----- ------ - __ _ Si ---- ------------ --------- - --------------------------------- -------------------------------------------------•-------------- - - -------------------------------------- --------- - PERMIT No. ISSUED `I)- -�`-{rz- SZ� (Date) FINAL INSPECTION BY----------------------------------------------------------------- Date------------------------------------------------------------------------------- F SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street f Stockton, California i ES-9-2M 9-50 W=1634