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`3 17 APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Pr e to the San Joaquin Local Heaith District for a permit to construct and install the work herein described. This application-is r. a in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----/.F--,7- -------- - -- - t ------------------- --------------------------------------------- Owner's Name-----------------'- --'------------- r ti_:R � - ----- ----- ------------------ ----------- - ----------------------- ------ Phone----------------------------------- Address---------------A_2_7_2--------------- 4-- l► ''� A ? ----------------------------------------- Contractor's Name--•--------- -�-��_�-�--�--�-�---�-�--�------------ = ----------------------------------------------- -- Phone---Z----�-9-Q--g------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M4 tel ElOther El Number of living units: Number of bedrooms :Z Number of baths [Z Lot size------74-- --- 70--------- ____ Water Supply: Public system Community system E] Private F-1 ` Character of soil to a depth of 3 feet: Sand [I Gravel E] Sandy Loam.❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Q 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-----------------Distance from foundation-------------------.Material ____------_--_ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid de-p--t--h----------------------------------------- ------- esspool: 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---------_--- -_ p al Field: Distance from nearest well--!On------Distance from foundation__- �_ -_--Distance to nearest lot line--.-_I.4__�__ is� Number of lines----------- Length of each line____--- // j g f;Width of trench -------------------- Type of filter material-- -� ---R4 -Depth of filter material-------_12— --__ Remodeling and/or repairing (describe)------------------------- ----------------- --h_17-1I_-0_-�______ f - I hereby certify that I have prepared +his application and that the work will be done i- accordance with San Joaquin County ordinances, State laws, and rule and re regulations of the San Joaquin Local Health District. (Signed)------------ ------------ --�n-�.r�------------- ----- ------------------- Owner and/or Contractor) ------------------------- ------ By:-------- --------------------------------- -------------------- - - --- -- --- ---- -- --------- -------------(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------------------------ --- -,<-— ----- -- ------------- -------------------- ---- - - -- DATE------------ - -- REVIEWED BY------------------------------------------ --- ---1--------- -- -------- ------------ ------------ - DATE � � ------------ ----- BUILDING PERMIT ISSUED--------------------------------------------------------------- ------- ------------- ------- DATE-------------- ----------------•-------- --------- -- -------------------------------------- Alterations and/or recommendations______________________________ _ --------------------------------------------- ----------------------------------------------------------I-i-----�- �j�-----••------- ------------------- PERMIT N0.-----3- //---------ISSUED 5 �J% /�� -��-.�-_-----{Date) FINAL INSPECTION BY------------------------------------- Date----------------------`VA"',ZSI } l� SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street Stockton, California E5--4-2M 9-50 W-1639