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APPLICATION FOR SANITATION PERMIT I/ V (Complete in Duplicate) _A. lication is hereby made to the San Joaquin Local-Health District for a-permitto construct and install the work-herein described. Thiisapplication is made in compliance with County Ordinance.No. 549. • a---------- JOB ADDRESS AND LOCATION-- ___,„ 'c-� T f1 _et� a�).0 ------------ ------- --------------------------------- . Phone_ Owner's Name_ .L� ------ ' ------ ? _ �W ~� `+' �� /if -- f!] Address--------•- -------------- -- —� _ V&-1------- ,, r ----- Phone �� •Contractor's Name E /'-l' TX- r I Installation will serve: Residence Apartment House ❑ Commercial ❑ Traile Court ❑ Motel ❑ fO�her Number of living units: '© Number-of bedrooms-0 Number of--baths ® Lot size ------X-11,67/—---------------- Water Supply: Public system R Community system ❑ Private ❑ TM' Gravel Sand Loam ❑ Clay Loam ❑ Clay [� Adobe [ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ Y / N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public''sewer is available within 200 feet.) from foundation- ----------------Material_____-____-____ _____-__- __-____- Septic Tank: Distance from nearest well No. of compartments--"----------------------Capacity--,_--------------_------Size--------------- Liquid depth--------------------------; ? Cesspool: Distance from nearest well_-______.- Distance fromF dation_ Size: Diameter_______________-__ _ ---------- Lining material-___-- ❑ -----------------Depth-------------- ----------- w 'Privy: � '; Distance from nearest well--------------------------------------"-`�-` --Distance from nearest building--------------------------------------- . � ❑ stance to nearest lot line---------------------------------------I--------- +�� .� Dl . � �.. �. ff f Seepage Pit: Distance to nearest well.-�/-f� -_-___Distance from foundation�� _r----.D�ta�nce to nearest lo�e__%��-___-, Number of pits-_ t -'-------Lining ma#erial� W, _ t'i_+-Size: Diame#erg` ----------Dept ti k _ ! j Disposa4 Field: Distance from nearest well____-__ -__-___Distance from foundation----------------- -Distance to nearest'Io# line___- ---___ ❑ „ Number of lines-----------------------------------Length of each line-----------------------------Width of trench---------•------------------------ { 'b Type of filter material- __- -------Depth of filter material---------------------- r Remodeling and/or repairing (describe):___----_ - --------------------------------------f ---------------------- -------------------------- ------------------------------------------------------------------------------------ ; -------------------------------------------------- --------------------------------- ------------------------ I hereby certify that I have-prepared this application and that the.work will be done in accordance with San Joaquin County ordinances, St laws, and rules ulations of the San Joaquin Local Health District. I ' 4- C, - /-YL• ----- �` towner /or C ntractori Si ned _ ------ --- F1 _4( g L--------- -- �`- °------------ -- - '� 1`A---- ►- _(Title]SY ---- - -- ------------ - - (Plot plans, showing size of lot, location of system n relation to wells, buildings, etc.,: must be file with this application]. FOR DEPARTMENT USE ONLY ' t , ------------------------------ - ----------------- APPLICATION ACCEPTED BY ------ DATE-------------- / . ------- ----- DATE--- --- ------�-`-----i-------------------------------- -DATE �--�------- ------------- REVIEWED BY r = -DATE-------------------------- ---- 4 --------------------------- --------------------- ----------- y BUILDING PERMIT ISSUED---------------------------- --- -y -------------------------------- Alterations and/or recommen _ati__, ______,--� ---_- ------- __ ----------------- A---------r-ry..��rr.tir ----------------------- ------------------------------------------------------- ------------------ -------------------`---__----_----------------------------------------------- ------------+---------------------------------------------'------------- ----------__----___-__-__-- ___-____._- __--•--____-_._____------ _ --------------- - ;t--------- D --------------�.�.--- ,---------------- -- Ir 1 6 ----------- atE 'FINAL INSPECTION BY:--------_ PERMIT No.--77.0------ ISSUED------ ---- { Date---------- ------- --------------- '� ---'------- `"�---------/r------ SAN JOAQUIN LOCAL HEALTH DISTRICT e , 130 South American Street Stockton, California ES-4-2M 4-50 W=1634