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APPLICATION FOR SANITATION PERMIT )1/� (Complete in Duplicate) 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 County Ordinance No. 549. t JOB ADDRESS AND LOCATION-•------- 'Z..... � -------- -4�-4------•---•--------------•-----•---•----- -------- Owner's Name - FR e l 0-10—----------------------------------- Phone---- ---AdAddress------------------- dress------------------- /`/{� �� ----- ------------------------------------- .• /!rw'Contractor's Name------ ------------------------� � -, p ---------------------- Phone.............................. Installation will serve: Residence 14 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: E] Number of bedrooms ® Number of baths [.ZLot size----- ____t.Y_.'��__ ........................ - Water Supply: Public system ❑ Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ['K Clay Loam ❑ Clay ❑ Adobe❑ Hardpan' i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- i Distance from nearest well.6&47.._.Distance from foundation....2- -------Material...COXCs..Re-s,L_� ,= No. of compartments__...._._2 ......---Capacity-----9'42-----Size....$X_ _, -� --Liquid depth s Cesspool: 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------------------------------------------------ Seepage Pit: Distance to nearest well--------_.............Distance from foundation-------------------:Distance to nearest lot line..... ❑ Number of pits----------------------Lining material-----------------------Size: Diameter........................Depth---------------------- Disposal Field_. Distance from nearest well LP�--Distance-fro n foundatDistance to nearest lot line 4,� '• r 99 Number of lines_..__-�- --------- -.----------Length of each line �j�-�i 6-'.Width of trench......._- ---- -�x:ZryW Type of filter material.........................Depth of filter material----------------------- Remodeling -__----____ _-__•-___Remodeling and/or repairing (describe):----------------------------------------- ----------------------------------------------------------------------------------------- ..........................•...._._..--------------------------------------------------------------------------' -----'------------------------------------------------•----------------------------------- ii erw. m 1 hereby certify that I h ve prepared this application and that the work will be done in accordance with San Jef'arquin ordinances, State , s, an Iles regulations f t San Joaquin Local Health District, .._,. (Owner and/or Contrec (Signed) -- -------- ---� . -------- - - - --�--- - - ----------------------------------------(Owner ----------------------------------------------------...............(Title)-------------------------- ------•------------ --- ,• z (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 APPLICATION ACCEPTED BY-----*.X-V&—� ------------ DATE------- REVIEWED BY------------------------------- ----------- -- - DATE------------- BUILDING PERMIT ISSUED.........____.----�/ ,- - ,// ------------ DATE-.--------- Alterations and/or recommendations:_...__ 0 / _. T�/ -- ,. -'-•.- '-.,. .-_ -...___..'.-- ...-_ -_-l____ __________ ....._.__ _ -�-._.... ------ _...___*---------/4� _.__....-_. _..__ --------- '- ------------------ PERMIT No---------------------- ISSUED.. I�... {Date) FINAL INSPECTION BY:...._ ................... _-"1�r----------- Date �_. . !� 4 `. 1 " --•---•---- . Date._._,.-..__ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639