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APPLICATION FOR SANITATION PERMIT r'}" (Complete in Duplicate) u Z� Application is hereby ma to the San Joaquin Local Health Distric+for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- t/_- .151 ------- /. •�- ----. . Owner's Name------------ A------ 1/U' ' - -- ----------- - ---- --------------- -------------/,lJ� Phones_-__--------- Address------------15. •--•- . - 1 Contractor's Name-----•......-•-•-------------•----•• --------------------------------------------------------------------------------------- Pho ---------------------------------- Installation will serve: Residence Apartmen ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: (�] Number of bedrooms [ Number of baths ] Lot size------cS. ja_.Q_........................ Water Supply: Public system ❑ Community system ❑ Private (� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well-/044.''_Distance from foundation �- g.Material- — -------- -� No. of compartments-------------2.,.......Capacity------9_00_ ------Size--- T-Yi-�---_Liquid depth... --- 7 Cesspool: Distance from nearest well..............___Distance from foundation____________.______-Lining material.------------------------------------- 171 Size: Diameter--------------------------------------Depth--------------_- ----------------------------- Privy: Distance from nearest well-____________________________________________ Distance from nearest building------------------------------------------ El Distance to nearest lot line___-__-____-•___________________________________ Seepage Pit: Distance to nearest well-___-_--------------Distance from foundation--------------------Distance to nearest lot line-_--_____.__-____ ❑ Number of pits----------------------Lining material----------_--.-------Size: Diameter----._ _.-----------.Depth.--___---------------------__.--- f3isposal Field: -- Distance-from nearest eII Q A;Distance from foundati __-___ i ce_to_nga,�t lot line,_� Number of lines Length of each linez97.3.�-2.0-•� of trench-_•2 Type of filter material_. Depth of filter material________�_ _�_ :__ Remodeling and/or repairing (describe):.-------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- i --------------------------•-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------............. 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 and/or Contractor) By:----------------------------- (Title)-- ----•---------- --------- -------- --- -------- -------------•------ --------- ------- --------- --------- ------------•---- (Plot plans, showing size of lot, loca+6n-of system..in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------------- ---------- ---- --- --- ---------------------------------- DATE-----_-------------•---- •-------••-----_----_- REVIEWEDBY------------------------------------------------------------------ ---- -- �----------------------. DATE.----------- ---------- BUILDING PERMIT ISSUED-------------------------------- ----- --- -- --------- Alterations and/or recommendations----------------- -----•-------_ ----------------------------------------------------•------•----------------•------•------------------------------------ --------------------------------------------------------------------------•--•--------------------------------•-•---•--------••--_---•-••---------------_•--•----•--------------•--•-----------•---------------•---------_ ----------------------•--•---------------.............-----------------•------------------------------------------------------•------------•---------•------------------------------------------------------- ----...... -----------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------•------•--••-----•-••------•-------••--•--------••------------------•----.-----••---.........................................................-------------- --------- ----------- PERMIT No......................... ISSUED------------------------------------------(Date) FINAL INSPECTION BY------------ -- "' Date----------------4 r f �-•r`- 3 — ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639 -