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,2-,o y 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 AND LOCATION-------,1_ 2-,Z Owner's Name------ ------, --------------- ----------------------------------------------------------- Phone_ -o z--?/ ------- Address------------------------------------- ------Address--------------•-------------- ------- Contractor's Name------ ------------------ Phone---f Z__10_7 Installation I will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ® Number of baths V] Lot size---71 ?4_____�( ►_p_'_____________________ Water Supply: Public system Community system ❑ Private ❑ X11 .Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe &�. Hardpan ❑ 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 depth-------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- ElSize: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well_________________________________________________Distance from nearest building----------------------------------------- 17 Distance to nearest lot €ine_-_____________________________________________ 1 Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----------------- F1 Number of pits----------------------Lining material-----------------------Size. Diameter------------------------Dept h---------------_------_____------ Disposal Field: Distance from nearest well_'%`��✓_.Distance from foundation_.'�a*--------Distance to nearest lot/line_..,-_--_____ '� Number• of lines------------l�__ _ Length of each line_______�p_Q___----------Width of french---e�_�"-------____ ---------------- Type of filter material_I7�-��/el ------Depth of filter material_,_f____L_�-�!-------- / Remodeling and/or repairing (describe__________________ _P��s7�x� __ p----:---- - -- .... P�191__C1lr- ------ ---------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State l , and rules and regulations of the San Joaquin Local Health District. (Signed) { 1*Contractor) } -- -- - - ---------------{Title) I r - - - _� '_ -x��7`�-,e..�---------------------- (Plot plans, shkwing size of lot, locate n of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �r DATE___________ J_ ___ __ fREVIEWED BY----------------------------------------------------------------- --- ----------------- ----------------------------------- DATE-----------, ----- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE - -------------------- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------•------------------------ PERMIT No.___.2 __-------- ISSU ------------(Date) FINAL INSPECTION BY:-------4 4 P Date---------------Z � 1 ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-9-2M 9-50 W-1639 r