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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) a 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. r JOB ADDRESS AND LOCATION_ 7 : ________- ------- -- -------�-------------------- Owner's Na e -------------- ----------------------------------------------------- Phone 1 -- r- Address-,----- •-- -- ----- ,rrc �. -� - --------- - -------------------------•----------- __.______ ___-____-•___ YF_ i Contractor's Name___- _ Installation will sery - - T ------- Phone_ ____- _-_ - ----- - _ e: Residence Apar ment House ❑ Commercial ❑ Trailer Court � Number of liven units: ❑ Motel ❑ Other ❑ g Number of bedrooms] Number of baths„ Lot size 1�e A.- . k Water Supply, Public system ❑ Communitysystem Y ❑ Private Character of soil to a depth of 3 feet: Sand A 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 ��_ _ I Distance from foundation__-_.�___o�___.M terial No. of compartments -_--- y� p '----- -----Capacity,yJ 0--0---------Size Liquid depth_-- ------- - - -------- Cess -------- Cesspool: yX --°2 p Distance from nearest well_________________Distance from foundation------_-------------� ening material p Size: Diameter----------------------------------------Depth-------------- --------------- Privy: Distance from nearest well____________________________ Distance from nearest building Distance to nearest lot Zine----- -------- ------------- ---- 9-- ------- -------------------------- Seepage ------• -------Seepage Pit: Distance to nearest well----------------------Distance from foundation-------.------------Distance to nearest lot line.____ Number of pits----------------------Lining material-----------------------Size. Diameter------------ -----------_. Dispo I Field: Distance from arest we _------_- _ "~^�`^ Depth-- ----------------------------- ::__Distance from found�afio "rDist"a ce to^earest pt fine__ 0 Number of lines_ _ g 9 0 �__-----___ Length of each fine____ ________ Width of trench_-�------____- Type of filter material_ _- ------------- -----"------------ __Depth of flier mat rial__f________________ Remodeling and/or airing (descr e) -- --•- -- ---- -- ------------- ---------------------------------- ----------------------------------------------------- I hereby certify that 1 have prepared the application and that the work will a done in accordance with San Joaquin County ordinances, a laws, nd ules and' egul o of the Joaqui ocal He h District. i weer and/or Contractor) ___-(Title) _____ (Plot plans sh ing siz of lot oo tion of s em in relation to wells, buildings, etc., must be filed_with this applica ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYLl�-------------------------------------------------- DATE_ REVIEWED BY --------- _�' ----------------------------------------------- BUILDING PERMIT ISSUED,--------------- f === DATE--- = ----=------------------------------------------------------- - Alterations and/or recommendations:___--------'•-____-- DATE •--------------------------- -------- --------------- --•----- ----------------- �+ ---------------------------------------- q/ --------------------------------------- PERMIT N I ISSUED----------- -- v� / - � - - -- � ------�-----�=-_ ate} FINAL INSPECTION BY:________________ ---------------------=-------------------------- fl �� 2�. Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California