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APPLICATION' FOR SANITATION PERMIT (Complete in D licate) pplicaiion is hereby made to the San of aquinAa Health Di 'ct or a permit to construct and install the work This application is made.in compliance with County/Ordinance No. 549. k herein described. + JOB ADDRESS AND LOCATION___ j6--- 47 r -- - -------------------------------- ------------------ -------------------------------------------- - Own'er's Name-------- =------ � --- ----- Phone--- --- - Addresse -- ------------------------------------------------------------------ Contractor's Name----------------------- ------------_ --------------- Installation will serve: Residence (, Apartment House ❑ Commercial ❑ Trailer Court'❑ Motel'❑ Other ❑ Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size__________________________ - --------------------------------- ater Supply: Public system ❑ Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -'INo septic tank or cesspool'permitted if public sewe`r'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____________________ El 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--------------------------------- Dispos I Field: Distance from'nedtest - 'Distance' to nearest lot----Depth of filter material _��4 Number of lines------------1----------------- Length of each line------ Width of trench___ p r,--------------------- ---_----_ •_ Type of __filter material_-_I- .--_ _______` lil _ - -- ------- Remoodeeand/or re airin (describe):___ _6 it ..r-,re ----------- ----------- -?i ,- ----- ---- ---------- - ------------- ----------- ---- -- ----- ---- ------ ------ - - ----------•------------------- I h eby certify that pr pared this app lication 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 •istrict. (Signed)--- --------- ' -1 ,T 7 ---------------(Owner and/or Contractor) By:---------- ------------------- ------- - (Title))---------------------------------------------------- — (Plot plans, showing size of lot, cation 'f system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._-------_____ --= -- ------ -------- ---- DATE------------ --=-r---- crREVIEWED BY BUILDING PERMIT ISSUED--------------------- -- -- - - - DATE1-1 --------------------- --- --------------------------------------------------- DATE------------ Alterations and/or recommendations: a == ----------------------------------- ��a t R ---,-�---- ---ti--- ---------------- ------------------------------------------------------------------------------------------------------ - = ---------------- -------------------------------------------------------------------------------------------------- ---------------------------------------------- - --- - ------------------- -- ------------------------------------------- --------------------- ------------------------ PERMIT No.__:!'J._ __------- ISSUED------- --f�-"--- _ ______(Date) FINAL INSPECTION BY:.--------- Date---- _.Date---- `,-=------- ------------------------- --- SAN JOAQUIN LOCAL HEALTH DISTRIC �. 130 South American Streeter Stockton, California — ES-9-2M 9-50 W-1639