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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 ANp�,OCATIONh1i6A P 1 Owner's Name Name------ --- ----- -------- -- ------------------ --•- ��` ------71�"�7:�-;- 3 ------------------ -- ---- ------------------------------------- ------ --------------- PhoneAddress � -------------------- � .!•��-a--- - ' - ontractors Namo_.___-._.._ -------------- --- -------- --------- ----=---- --------------------------- ----- --------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ - Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 82�Number of bedrooms E:12.Number of baths b/4 l 4�' ❑�Lot size_- ---- - -------Arb--=------------------- Water Supply: Public system ❑ Community system ❑ Private PT Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe❑ Hardpan ❑ W TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.]. J* Septic Tank: Distance from nearest well___ "_-_"_bistance from foundation _________.Material_ t% VW�1 07 �` No. of compartments------Pt---------------Ca acit 3? 3�x __.. -- --t------------ p Y -Size- -----Liquid depth-------------------------- Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material-------------------------------------- Size. Diameter--------------------------------------Depth--------- ---------- ------------------------------- "Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildingEl 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---------- __ / :/O j .Disposal Field: Distance from nearest well...�'p--------Distance from foundation__-��..___.__-_Distance to nearest lot line................ 21 Number of lines__________ .►____-.._...__-Len th of each line-_..____ � g ----- Width of trench--' 4 -----.- -------------- Type of filter material-... IrDepth of filter material-..-__ ��"" s- -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, r (Signed)-------------------•--- 11 ( V I -- --------- "" "" Owner and/or Contractor) I --------------------------------------------------- gY: ----- --•- 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 BY-------_._._ '::� / REVIEWED BY - ------ ---- --------------- ----- ---------- ---------- - ------ DATE BUILDING PERMIT ISSUED..................__-_--_-- - --------------------------------------- ------- DATE------------------------------------ --- -- •- � -- ------- ---�-------�----------------------------------- - ----------- DATE-- ---------------------------------- Alterations and/or recommendations: ............ ...... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------- ---------- .---- - - - - - ------------------------------------------- -- PERMIT No._/__-_a"_" -"""" ISSUED------ 1.-%_7__. __--_____(Date) FINAL INSPECTION BY:____1�� /�'' y Date------------1D-- - ` r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Es=9-2M 9-50 W:1639 Stockton, California