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APPLICATION FOR SANITATION PERMIT X3- � a (Complete in Duplicate) .. f43 - 2&-0-1l. Joaquin Local Health District for a permit to construct and instal4 the work herein described. Application is hereby made to the San Thisap lication is made in compliance with County Ordinance No. 549. t rr JOB ADDRESS AND LOCATION_ ---- ---- -- ---------- Phone Owner's Name___ ______ ----------------------------------------------------------------------------- * Address----------------- - ---------------- Contractor's ------ Phone- ------------- - ------- -------- -=----- -------- ----w-------------- Contractor's Name--- ----------------------- ------ ----- Motel Other E]Installation will serve: Residence% Apartment House ❑ ' Commercial ❑ Trailer Court [:] / ❑ er f Number of living units: "[�] Number of bedrooms [�,, Number of Oaths 0Lot size--- Water Supply: Public system ❑ Community system ❑ L Private w Character of soil to a depth of 3 feet: Sand X Gravel ❑ Sandy Loam [IClay Loam C1 Clay E] Adobe C] Hardpan [I `TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 204 feet.) t -__-__Distance from foundation)I--------" aferial_- --- ----- --- -- Septic Tank: Distance from nearest well___ -_.'?_ j? t / jy ?__ Liquid depth___- J-______- Capacity �� Size ii77 No. of compartments____________ __ - Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material------------------------------------- ❑ --------Depth ----- -------------- ---- -- - - Size: Diameter--------------------------- --_--__-_-_Distance from nearest building__ O Privy: Distance from nearest well---------------------------------- --- ' ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- Size: Diameter------------------------Depth--------------------------------- s ❑ Number of pits______________________Lining material----------------------- -Disposal field: Distance from nearest well -_-.Distance,from foundation_--3-7--_-___-Distance to nearest lot41�in _�--------- I Number of lines_______________ _____________ ength of each 4n ----------Width of french ----__- Type of filter material_ ----- --Depth of filter material.__-.. //----- "Remodeling and/or repairing (describe)-------------------------------------- ------------------------------------------------------------------ ------------------------------------------------------------------ - y y ----------------------------------------------------------------------------------------------------------------------------------------------- ---------- -------- --- ------------------------------ --- hereb certif 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) &_J55t�-- ./► 7e——-- ------------ ---------- • (Owner and/or Contractor} -- - -- ---------------------------------------- Tale -------------------=------------------------------------------- (Plot plans, showing size of io+, location of system in relation to wells, buildings, etc., must be flied with this application). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------"--------------------------------- ------------- -------------------------------------- DATE---------------- ------------------------------------------ ' --- DAT - r ^ REVIEWED BY---------- ----- --- --- -------------------- -- j BUILDINGPERMIT ISSUED----------------------- -- --------------------------------------------------------------- DATE- --------------------------------------------------- Alterations and/or recommendations--------------------------------------------------------------------- --------------------------------------- - - - ------ - - ------------------ - --- -- � a Date FINAL INSPECTION---B--Y---:-------------------- PERMIT No.-A_ ISSUED } 1 /')--I " Date--------------------- E SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California R ES-9-2M 9-50 W-1639 '�