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APPLICATION FOR SANITATION PERMIT _ (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health Disttict for a permit to constrruuctand install the work herein described. This application is made in compliance.with County Ordinance No. 549. 3q66 nJctrb 4-c,' 7 - k, p -- -- JOB ADDRESS AND LO.CATION `3LD(, _""'4 V �=�-------- --------------------------------------------------------------- Phone---------------------------------- Address-------------------------------------5 - "`- ------------------------------------------------------------------------------------------------ ------------------------------------------ ^ Phone---------- ----------------- Contractor's Name------------------------- - ------------------------------ Installation will serve: Residence Apartment House F-1Commercial [I Trailer Court ❑ Motel El Other ❑ Number of living units: F-1Numberof bedrooms t Number of baths JA Lot size---------------------- Water Supply: Public system ❑ Community system ❑ Privatex t Character of soil to a depth'of 3 feet:' Sand F1 Gravel F1 Sandy Loam El Clay Loam [] Clay ❑ Adobe Hardpan ❑ Ilk TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200.feet.) ! Septic Tank: Distance from nearest well____,�Q-_--_Distance,'from foundation------ ----------Material___CO41C- — e_J -------- No. of compartments--- •----- ------------Capacity__�S?d_ I-----Size__H_X__ ------Liquid depth------'j�-------------- Distance from nearest well_________________Distance from foundation-----`___:_______.Lining material-______.________-_________ ---- - Cesspool: ❑ Size: Diameter----------------------------- Depth 'Privy: Qistance from nearest well_____________________________ -______-.-..-_______Distanc.e from nearest building------------------------------------------- ❑ Distance to nearest lot line------------------------------------------------ rom foundation--------------------Distance to nearest lot line----------------- Seepage Pit: Distance to nearest well_____________________Distance f ❑ Number of pits-----------------------Lining material----------------------"Size: Diameter------------------------Depth------------.-------------------- Disposal Field: w Distance from nearest well___.��__ -_____.Distance from foundation__;__r�P�____-_Distance to nearest lot line___!Sf_--_ p Number of lines------------- -------------------Length of each line---:7r� -----------Width of trench----e�--�_---------------------- Type of filter material__t,[.P_1�--------------Depth of filter mJaterial-------_s?_--_-___.__- Remodeling and/or repairing (describe):----------t4-g,lA.�-------G a��'>�i��T'1 IQ_L�_ ---------------------------- --- -; ------------------------------------------- r ---------------------- :---- -- -------------------------------------------------------------- ---------------------•-------------------------- --------------••------------------------------------------------------ k -----------------------=-----` -u I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin oun R ordinances, State law and rules and regulati ns of the San Joaquin Local Health District. -----------------------------------------(Owner and/or Contractor) (Signed)---- - ----- -------- + ------------------------------------------- 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 1_� --- DATE-------- ._ — ---- APPLICATION ACCEPTED BY___________ I__ -------- ----------------------------- �. f --------- DATE------------------------------------------------------------ - -------------------- DATE--------_---------------------------------------------------- BUILDWG PERMIT ISSUED------------------------------•----------`----------------------------------------------------------- -------- ------ - ..- Alterations and/or recommendations--- --------------- -------- ----- • ----------------------------- ---------------------------- - -------- ZA4 - ----- � -- ------------ �: --------------------- ----------------------------------------------------------- !--------------------- --------------------se ------ ------------------ ---------------------------------------------------- ------------------------------- ----------- ----------------- -------------------- - -- 1`,G_--(Date) FINAL INSPECTION BY----------- X------ PERMIT No.�_,q ------- ISSUED---------- -le4Y7--- �-'If Date----------------------------- f7__ _.. ------------ --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639