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APPLICATION -FOR SANITATION PERMITy� (Complete in'Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work-4 e n-describec[L.A _ This application,is made.in.compliance..with County Ordinance No. 549. w 1 1,y JOB ADDRESS AND LOCATION_ :_:__. •-+ - / Owners Name__.__ . > Z ,&.$� + ��. ;: --• - --•------ + �� r ff Address --------------------------- �7�.... _ ( .� ne -. - ---------------------------- x o Contractor's Name_---fa�i-/ �..Y_a, . •r_. � ' ,,; ----------------------------•--- Phone__ --S---a' ?'�t� . t , Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ ' Motel ❑ Other $�- { Number of living units: fl Number of bedrooms El Number of•baths E] Lot size______________________________ a ''`, Wafer Supply: Public system j] . Community system C] Private" 7 Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam�❑ Clay Loam fl Clay ❑ Adobe � Hardpan j , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept ic�Tank: Distance from '. nearest well-_A©.....-_Distance_fro-m---fo--un--ds ion � -- L � -----------------------�-- _ No. of compartments---------- ------Capacity ze ----- quid depth--�Z------ ------ -___... aMaterial--- Cesspool: aterial.__Cess ool: Distance from nearest well____ ----..-Distance from foundation--------------------Lining material------------------------------ ❑ Size: Diameter--------------------------------------Depth-•------------------------------------------ Privy: Distance from nearest well------------------------------ _________________Distance from nearest building - -------------------- ---------- - ❑ Distance to nearest lot line y Seepage Pit: Distance to nearest well--/-r4?--FDistance'from foundation_____` /12 Distance to nearest lot line_________________ Number of pits________-_____--__Lining mate ria lj__- -------Size: Diameter';__. �� ------.Depth-----^�_�+�---------------� � ' A Disposal'.Field: -. .Distance from-nearest well...__ _,-,-.Distance from foundation____;_ "� _:Distancerto-near-est,lot-line ��.�_-_ Number of lines-----------•/---"_--------------Length of each line------ „�":- --- `-----Widfh of trench---A-41._'!----_-------- �� Type of filter material_ ' -----Depth of filter material------)-2--_ �_-,___ # # r Remodeling and/or repairing (describe)__________________________ ------------- -------------•--------------------------------------------------- ________________________________________________________ b ___________________________-------_!_-----------------------------------.____-____..._____.________-_--_ __________________________._.______--___-_______-______.__________________________-_-._____-__-___.______------_____--___________--__-__-"_____________.� __ _._-______-__-____.-_________-.-------------------------------- hereby certify that I have prepared this application and that the work will be done__in_e_accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ ' ------ ------------ ------------- ---------------- ---------(Owner-and/or Contractor) ---------------------------------------------------------------------{Title]_- •�+-�•.-.,.as�_.e�-t--------------------------- (Plot plans, showing size of lot, location of system in relafion to wells, buildings, efc., must be filed with this application)., FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____________ __ lir- - ------ REVIEWED BY ------------------------- DATE---------------- ------------- - � cfCh 5 - ------------ ---------------------------- DATE_ -v. a BUILDING PERMIT ISSUED_____._-____ - ---_-_-----------------------------=------•------------------------------------------ DATE---------- ' Alterations and/or recommendations_ -----------------a ---------------- ------ i ------•-•---------------------•-•--------------------------------.............-------------- ---------•-------------- ----- -- -- --- -- - PERMIT No. I'_�S_--------- ISSUED---- ---` -�_"--_ {Date] "FINAL INSPECTION BY____ ____ _____ _ Date # -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street M 9-50 W-1534 Stockton, California 2