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;NOW-- ' APPLICATION FOR SANITATION PERMIT - g tDuplicate) (Complete in Du.� P ) Application-is hereby made to.fhe 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. ADDRESS AND LOCATION___________ _�-�-_ _____ ---�-- ------- ------------------- JOB ; _ fi i -pe,(-'---f-------------- Phon err �. Owner's Name-------------------- ------ � :- :�' � t .V- ---------------------------------------------- Address = Phone ',�� -•-- ------ -- � �I __ _ ,..+ Contractors Name----------------- Installation will serve: Residence [ Apartment House,❑ Commercial ❑ Trailer Court ❑4 Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths ], tLot size___r -62__. -- ---- : f'1 Water Supply: Public system ❑ Community system ❑ Private 62 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�Hardpan ❑ 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 from foundation _____.Material__________--_-____.,------------------------ No. of compartments:---=---------------------Ca' acit _ Size - Liquid.depth___ - p Y Cesspool: Distance from nearest well________________ Distance from foundation-------------------linin material-------------------------------------- f" ----------------- Size: Diameter------------- ------Depth---------------------------------------------------- i ❑ , .�_ stance from nearest building------------------------------------------ Privy: 'Distance from nearest well----------------------=------------- D, ❑ Distance to nearest_lot line---------------____1 F------------------;-_ � -, ____.Distance.to nearest lot line----------------- -Seepage Pit: ' Distance to nearest well-- -------------------`_ Distance from foundation_________:____ * h iNumber of pits----------------------Lininmaterial-- ----------------Size: Diameter--------- - ----------Depth--------------------------------- ` Disposal Field: Distance from nearest well 1-(?-------Distance from foundation ------- Distance to nearest lot line f Length of each line--- i',a -------Width of french_ - _J/-------------- Number of lines_________ ___ ______ _ ffrr , fI Type of filter material_ a�__!� _ epth of filter material------ , -______ i Remodeling and/or repairing (describe�:__-- r �� ; -------•-------------------------------------------------------- I - r -x :-- + ----------- ----------------------- ----------------------------------------------------------------- --- ----------- ---------- ----------------------.------------ -------------- --- - -------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin oun District.- ordinances States laws, and rules and recfuI ions of the San Joaquin Loca Health District.- } ._ a � (Owner an or Contractor) (Signed] = to ________ (Title)---•--.A_ �' -- ---------- _ By:_ = - g y 'to wells, buildings, etc., must` be filed Vith this application]. � [Plot plans, showing size of lot, location of system m relation. -. FOR DEPARTMENT USE ONLY= ---- - ; APPLICATION ACCEPTED BY DATE :.- J I------------------ - ---------------- J DATE---- ---•----------------------------------------------- REVIEW BUILDING PERMIT ISSUED---------------------------- ----------- DATE------------------------------------------------------- Alterations and/or recommend afions_------------------------------------------------------------------------------------- ------------------------------- --------------------------------------- ------------------------------------------------------------------------------------------------ --------------------------------------------------------------------- - - -- --•------------------------- ------ - - ----- - ------- --------------------------•------------------------- ------- No.___ -�------- ISSUED___-__.l__/— ------------------(Date) FINAL INSPECTION BY:_-_____11�-� Date_ --_'- r-- -------------------------------------- `. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M "9-50 W=1539