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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) f 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 Coun+y Ordiri�nc T FS dfLo _t .,��.._.�: ,. �,•.-Lc-• -•=-`'---------'-°--`" ------------•------------------------ JOB ADDRESS ANO LOCATION.. ' --- w --- ------_=- --= 01 A . — _ _2 ------------------- Owner's Name - Phone-` �p 4 ►f1 •----- -- r -------=--iee r. - 'C. --_ CJ Contractor's Name-_�-L,�,. * _._ -_�'-e "'�__ - Phone__9=_A"___7 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 9. a Number of living units:.❑ Number of bedrooms ❑ Number of baths ❑ Lot size__________________________________-____.__----._.---___-_-_- 1 Water Supply: Public system;❑ Community system n Private ": w , � Character of soil to a depth of'3 feet: Sand ❑ Gravel �] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan 1 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__,_--.Distance fromfounda+ion-__f- ... _._._Material--- _,_---------- .: No. of compartments-------_�-:----------Capacity �- -----Size---_'•1__...... Liquid depth_-_-J'2-------- ...� Cesspool: Distance from nearest well- --- ----------- - from foundation--------------------Lining material----------------------------- Size: Diameter---------------•----------------------Depth---------------------------------------------------_ Priv Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------- ❑ Distance to nearest lot line----------------------------------------------- 1 Seep a Pit: Distance to nearest well------��_Q-__Distance from foundation---- -_r_.-_.D'stance to nearest lot line--- -_--_ 1 F Number of pits--------I-----------Lining ma+eriaL.A __l '---Size:,Diameter-_- e -----------.Depth-------AA---------------------- Disposal Field: Distance from nearest well____e'N�-----Distance from foundation-----/&4__-------Distance to nearest lot line_____- a Number of lines----------___f -----------------� Length of each line_-_- _.IU7.........i.Width of trench-------A 4l__'_'__-- � Type of filter material-! _-!_ __-Depth of filter materia ---------- t , Remodeling and/or repairing (describe)--------------------- -----•-------------------------•--------- --------------------- -------------------------------------•-------- r -------------------------------------------------------------- ------------------ ,. I——---------------------------------------------------------------- = - ------------------------------------------------------------------------------------------••--------------- ----------------- 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 rules and regulations of the San Joaquin Local Health District. (Signed) ......'-��--- -� ��'� ---------------------------------------------------------- Owner- nd/or Contractor Si ned lt BY:---l-r�r�r' - -r`�`.� �t._ =------------------------------------------------------------(Ti#le} -----------------•-------- ,f (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 r --- DATE �� ` � ''[ ------ APPLICATION ACCEPTED BY---------------- '�a/ .. % �/V • C-a � DATE---------------- � REVIEWEDBY-------------------------------------------------------------=-- --------------- - BUILDING PERMIT ISSUED--------------------------------- -------------- DATE - Alterationsand/or recommendations-----------------------------------------------------------------------------------------------------------------------------------------------•--=--------- --------------------------------------•-----------------------------------------------------------------------------•-------------------- ----------- -----------------------------------------------------------------------------------•---------------------------------------------..... ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- PERMIT No.-/�. _ ----- ISSUED------ --- •-(Date) FINAL INSPECTION BY: - ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 40, Stockton, California ES-9-2M 9-50 W=1639 k�