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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 A LOCATIOfr-1-�-- -- - - ------ - ------ Owner's --- rOwner's Name. -----= ----------------------------- Phone--------- ` 2 sg Address................. Q - -------- ----- - - ---------------------•------------ ------------------------ -, - Contractor's Name--- -A----__-- _ _ - Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Moteli ❑ Other ❑ Number of living units: [h Number of bedrooms .Number of baths [I Lot Water Supply: Public system"X Community system ❑ Private ❑ Character of soil toga 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.) F y Septic Tank: Distance from neares?elP _f Distance from foundation------ Material_______ _---------------------------------------4 !�? ,..--.No, of compartments__________---------- depth___c�;-------_______- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------------- F-1 --_-__________________----_______❑ Size: Diameter--------------------------------------Depth------------------- -------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well'�1._rDistance from foundation__--_- --__,Distance to nearest lot line_--�------ �; Number of pits----- ----- g yr�r-----.Depth-------�'Q------------------ ____Linin material_�.vn.�_ �.SSize: Diameter______.. . s .Disposal Field: Distance from nearest welLn'1� ___.Distance from foundation_____ _7-------Distance to nearest lot line____x--_._-_- Number of lines_______________ _ Len th of each line____----- '' n � g >� ;; Width of trench_._ { Type of filter material f _~_�FO -Depth of filter material___--f-7_________-_ Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------- ------------------------••--------------------------------------------------------------------------------------------------------- --------------------------------------------•------•------------------'--------7:--------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------- I 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 r and' regulations o the San Joaquin cal Health District (Signed).... .. ` ------- ---- ---------- ----- - ----- tk- h-- --{Own�4-rY. tractor) ff - ------------ (Plot plans, showing size of lot; location of system in relatio to wells, buildings, etc., musthis application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- ------------------------------------------------- DATE_O---;; -rG REVIEWEDBY----------------------------------- - ------------------------------------------------------- DATE------ Q ---------------- BUILDING PERMIT ISSUED--------------? ----- DATE Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------•--•;---------------------------------------------- PERMIT No.__=x'-10______------ ISSUED----��-` .�-�`�-------------(Date) FINAL INSPECTION BY:-------- ----z_Ql------?-------------_-_------ Date-----------------------------1 / �'f J SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639