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APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) t 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 ,N1o. 549. JOB ADDRESS AND�CATION---------------------- ---------------------------------------- ------------- Owner's Name -- / 'T ..�o �J�f��I�I� W V `�I .r� U/� Phone------------------------------------ ./ ---------------------------------------------------------------------------- -------- Al Address ` ------------------------------- �---------n-----------------/--------------- lt!/f 'v�T �/ � Contractor's Name _48OUL Mfe--------------------------------------------------------------70 .(, [J��rU!e,--- Phone--------- ------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ( �7✓� Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size______________________________________________________________ Water Supply: Public system � Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ W TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public sewer is available within 200 feet.) O C•o g1e�l T� Septic/Tank: Distance from nearest well---- --�'------Distance fro? foundation------t-------------Material________________________________ ------ No. of compartments-------y--------------Capacity----600---------Size _-�--�?`r------Liquid depth------- ------------- V, Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ElSize: Diameter--------------------------------------Depth--------------------- ----------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------- Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundafion--------------------Distance to nearest lot line_____-_-_-.______ E] Number of pits----------------------Lining material-----------------------Size: Diameter-,-__----------------_.Depth-------------------Ss-f-•--- Disposal Field: Distance from nearest well_________--------Distance from foundation !,_______�___f Distance to nearest• lot line________--______ Number of lines_________ ____________ JLen of each line______ ` ` __-.Width of �,, ` -.--- Type of filter material____-M1b*,e_4E%pth of filter material __--,-_Z-F_`._--_ Remodeling and/or repairing (describe):---- �"`----•, I�7r1" l - '�' ----------------------- -•---------- -cul. ----•- ------------------------------------------------------------------------------------------ •-------------------------------------:!t---- --------------------------------------------------------------- -----------------------------------=-----------------------------------------------------------------------------•------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and rules anti gulations of the San Joaquin Local Health District. (Signed) ---R----- ---------------------------------------------------------------------------(Owner and/or Contractor) By----------------------- ------------------------------------------------------------------------------------------------------------(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------------ -------- ------------------------------ DATE . REVIEWED BY---------------------- -------------------------------------�- :-------------------------------------------------- DATE-------- _ ---- ------------------ ---------- --- BUILDINGPERMIT ISSUED------------------------------------------------- ------------- ---------------------------------- DATE---------- -------------------------------------------------- Aiterations and/or recommendations---------------------------------------- ---- o ' ' --'-�--?-- ---------- --------- --------- efl------------------------------------------------- ---- - - - f16--4-------------------- ------ ------------------------------------------------------------------------- - �- - - ---- sd , ; ��_�t ----------------------------------------------------------------------------------------------------- -- --=--- ------------------------------------------------------------------------------------------------------- ------------------------------------------------- ---------- --------------------------------------------------------� ---- ------------- ------ PERMIT Ncb_3--- ISSUED------- � -�-{Date) FINAL INSPECTION BY:________-� - - --------------------- � Date `� , � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639