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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. -- - ram JOB ADDRESS AND LOCATION _ �r ___ - --- . ----- -------------- �-- p �I OOwner's Name-------------- ------------ ----- ------------------- Phone------------------------------------- Address--------------------- -------------------------Address--------------------- Contractor's Name - '` '"'� 3 - ---------------------------------- -------- Phone-------- --- ��-? Installation will-serve: Residence Apartment House E] Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: ;6 Number of bedrooms J3 Number of baths Vf Lot size--____ Water Supply: Public system ❑ Community system ❑ Private ❑ 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ tA 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 _7"t tDistance r_m foundation__ _ ---------Material_____. � P 0No. of compartments___-__:=__ acit _ a_ -------___ 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_________________________ 1 Seepa a Pit: Distance to nearest well__-----------_ ------Distance fygm foundai-ion_______________-__.Dista ce�ito nearest lot line_._f_'�__0__ - ! ; . Y Number.of pits_____________________Lmmg material,________��_-_Size: Diameter______�1_ 0----_-___.Depth_______--�D_--_________ Disposal Field: Distance from nearest welI'7- 4-____.Distance from foundation__laDistance to nearest lot ling s Number of lines___•______. ________ Length of each line_______ rWidth of trench______-�?_�____________________ Type of filter material.._ Depth of filter material_____1 �f Remodeling and/or repairing '(describe)_______________________________________________________ ---------------------------------•--------------------------------------- -- -------------------------------- --------------------- ------------------•--•--------- --------------------------------------------------------------------------------- ------------- - --------------------------------------------------------------------------------•---------------------------------------- hereby certify that I have prepared this application and a work will be done in accordance with San Joaquin County ordinances, State laws, ani les and, r gulations of the San oaqui Local Health District. (Signed) L �y Owner and/or Contractor) BY= = -••---------- - -------------------------------------------------(Title)-------------------------------------------------------- ------ i (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-------------------------------------------- ----------------------- -- ------- -'-------------------------------------------- DATE ' BUILDING PERMIT ISSUED----------------- __1------------------------------------------ --------------------------------------- DATE - I A terations and/or recommendations: - ------------------------------------------------------------- ----------•------------------------------------------------------------------------------------------------ ----------------------------------------------------------•----------------------------------------l-•---------------------- PERMIT No. , �______-_- ISSUED_______ 1 ----------(Date) FINAL INSPECTION BY:-------V-k11! 1e_ d -------------------------•------ Date--------------- , kckrl SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California S