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xy 44 APPLICATION FOR SANITATION PERMIT (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. JOB ADDRESS AND LOCATION _ o_P-� � 0v ---- r ---- ------------------------------------------ --- Owner's Name. L'= --------- Address -------- Phone i Address----------------------•-----------------•-------------------- o d�---------------------------------------------------------------------------- - Contractor's Name----=------------- - ------ Phone--------------------------- ------ - -----------Wit'-`--1 2�--�- - - - ----------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I Number of bedrooms (- Number of baths V Lot size----------- _____________________ Water Supply: Public system ❑ Community system ❑ Private ❑- Character of soil to a depth of 3 feet: Sand K 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------ -------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- '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-------------------------------- p� Field: Distance-from nearest well___ --_r Distance.from.foundation-___�O--._______D.istance,tozearestFlot_live___.=_.._--- , Dis osa _ -y. - 4 y Number of lines.=__`_""y"L` -----------------Length of each line___7-S-`�`�______-Width of trench ___.-_______________________ Type of filter material___ �_x�9Qepth of filter material------_-_-_- ---_-. Remodeling and/or repairing (describe):__-- ___ ------------------------------ s �-� ---- --------arm- -------------------------- .-'-- -------------------------------------------------------- ` `�`" ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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) $y:----------------------- ---------------------(Title)--------------- --------------------------------------------- (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 13YDATI . Yb----------•------------- ------- REVIEWED BY---------------------------------------------------------------------------------- --------------------- --------------------- DATE--------------- ----------------------------------------- -- BUILDING PERMIT ISSUED------------- ------•---- --------------------------------------------------------------------------- DATE----------------------------------------------------- Alterations and/or recommendations------------------------------------------------I------------------------------------------------------------------------------------------------------------ ------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=------------ ---------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ PERMIT No._LY6----------- ISSUED--- -------------(Date) FINAL INSPECTION BY:._ _ a - -- ----- -. ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639