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54 - - 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. 1 r ----------------- f _ - JOB ADDRESS AND LOCATION - U u"_T -------L S N S , y -------- ---------------------- Phone_----------------------------------- Owner's Name = --- -----/ ------------------------------------- v Address-------------------- - �4 Contractor's Name"._, �.�, .�-CJ""C-�•- �--y----- ---------- --------- ---------- ---------------------------- Phone------------------------------ -•----------- :: Installs+ion will serve: Residence jo Apartment House El Commercial E] Trailer Court [IMotel L1 Other El Number of living units: Number of bedrooms .. Number of baths ] Lot size___ """__"_"" "_ _•�G_lC ---------------------` Water Supply: Public system Community system ❑ Private ❑. h Character of soil to a depth of 3 feet: Sand ElGravel ElSandy-Loam Clay Loam ❑ Clay E] Adobe❑ Hardpan ❑ • TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /4----•---Material--------------- --- --------------- 'r-' � - Septic Tank: Distance from nearest well_ -4---Distance from foundation-_--_.-____- i Size__e2 K---73 4ZgLiquid depth------`5'3-------- No. of compartments---------y----------Capacity__-. ------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------.__""______-- --------- ❑ ------- Size: Diameter-------------------------------------Depth---------------------------------------------------- Distance ----------------------------------------- Privy: Distance from nearest well-------------------------------- El from nearest building------------------------------------------ Privy: ---___.--- _-------- -------------. ❑ 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 --- // _/ _0r�____Distance to nearest lot line-_"`5_" ---- Dispos 1 Field: Distance from nearest wellDistance from foundat�o Width of french----------j� -;#--------- Number of lines----- ----- ----Length of each line er Type of filter material"1 L -----------Depth of filter material 1 --------------------------------- Remodeling and/or repairing (describe):--"---- ---------"------------------- -----•---- ---------------------- ----------------------------------------- ------ -------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County- ordinances. ountyordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. (Owner and/or Contractor) --- ------------------------------------------------------ (Signed) 4 -. r a Title - - - - - -------------------------------------------- ---------------------------------------------------------------- By•--------------- -------------------------- -------------------- buildings, etc., must be filed with this application). I (Plot plans, showing size of lot, location of system in relation to wells, 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------"""---------------------- -- DATE-------- f S - -------------------------------- DATE--------------------------------------------------------•- REVIEWED BY_ 0�j JI DATE---------------------------- - BUILDING PERMIT ISSUED---------- --------------------- -------------------------- Alterations and/or recommendations----------- --------___-_-----_---__.----------------------------------------------------- -------- ---------------------------- S --------------------------------- PERMIT No.5_S4__---_---- ISSUED-"""-_ -----_�.-t----------------- Date(Date) FINAL INSPECTION BY:."__"__ I --------------------------- - -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street Stockton, California ES-9-2M 9-50 W-1639