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J X 77 ` 4� APPLICATION FOR SANITATION PERMIT j (Complete in Duplicate) w: Application is hereby made to +he 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__-_- d �!o . F_!l�l �... `-----------------------•--------------------------------- 'f�/l.�l_�/__S_- �1�- //r '�'' Phone ------------------- Owner's Name---- -------------------- --- ----------- _ Address-----------------------:------ --------------------------- U_hG .To--------11 ��' ------------------------------------------------------------ Contractor's Name----------------------------------- -- ------------ &-ui V .,-/r. - Phone----------------------------------- House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence [] Apartment ❑ � Lot size--------- --a �-I-- -------------------------- Number -------- --------------- Number of living units: [Z Number of bedrooms [- Number of baths ❑ O rw Water Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand [I Gravel F1 Sandy Loam E] Glay Loam 0 Clay ❑ Adobe F] Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4. ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � /1 Septic Tank: Distance from nearest well_-_:__________Distance from foundation___________________-Material___________-___-__._________-_ �( �- 3_x_ x Size'__9'0o - -A- Liquid depth - " No. of compartments-------------------------.-Capacity---- �- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Dept --------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------___________-_-___-_______-__.__. ❑ Distance to nearest lot line------------------------------------------------ - ince from-foundation________________•__Distance t Seepage Pit: Distance to nearest well_- Dis+ o nearest 19tr�e.- Number of pits------/-------------Lining material__----- Size: Diameter-_- .�!-------------Dept h-------------------------------- Disposal Field: Distance from nearest well-________________Distance from foundation________________Distance to nearest atm'line----------------- e Number of lines-------------- � -----------Length of each line----------------•-------�.;---:Width of trench---------------------- -------------- f Type of filter material- --4�J-!Ok�trDepth of filter material------2?�f----_--- ._ '-Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------- ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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. �L r _____________(Owner and/or Contractor) ---- (Signed) --- '' � a Title (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY--------- ---`-- -r�- DATE----- �------ -'- -'-------------------------- - �------------------•----=-------------------------------- ` = �' ' 'r� REVIEWED BY-------------------------------------------- ---------------- ------------ -----------��--J-- r - DATE------ ----------•------------------- BUILDING PERMIT ISSUED ------ DATE------------------------------------------------------------- -------------------------- Alterations and/or recommendations----------=------------------------=----------------------------- - ------- ----- " = WX C --------------------------- PERMIT No._��-�--------- ISSUED...... -_'--7---'-��-------- --------(Date) FINAL INSPECTION BY---------------------------------------------------------------- Date----------------- --------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street a Stockton, California ES-9-2M 9-50 W-1639