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,..t.. APPLICATION FOR SANITATION PERM] -� ry (Complete in Duplicate) T 1 Application is hereby madekto the San Joaquin Local Health District for a permit to construct and install th This application is made in"compliance with County Ordinance No. 549, a work herein described. JOB ADDRESS A OC 1 14 NNh __ 0 " Owner's Name--�` r --------------------------------------------- i: Address- f7Phone " --- ------ -- -- ----. . " " � Contractor's Name-" __•e �_•_� � _ Installation will serve: Residence ( 3Apartment House ❑ Commercial Phone" a. ________________ ❑ Trailer Court ' ❑ Motel ❑ O#her ❑ Number of living units: [ J Number of bedrooms �Number of baths Lot size__d"e WaterSuPPIY' Public system mCommunity system ❑ Private ❑ i ---------------------- i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 14Hardpan ❑ 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--------------------Materiall__"----------------------------------------- Cesspool: " "_-_"- No. of compartments_____- -----------......CaPacitY Size -- Cess ool: ------Liquid depth------------------- ❑p Distance from nearest well-----------------Distance from foundation-_-_-_--___---_-__-.Lining,materi I_,__"" "___""_-__-__._ Size: Diameter------- Depth-------- �wy_. `� ----- ----- . ----------- - -Privy: Distance from nearest Distance from nearest Distance to nearest lot line _ est buildin epe Pit: Distance to nearest well__------_-"____--_-__ `✓�A' _ Distance f om f ation_"_-_ --------- _d' � < Number of pits____.____-__ Distance to nearest lot fine---- Lining material." Size: Diameter_ _____ isposal F' d; - -- ------- - 10 Depth - _ - Distance from nearest well_"-__"___""- � �--------------- -_-_Distance from foundation____________________Distance to nearest lot line__-__" Number of lines------------------------ Length of each of'trenc Type of filter ma+e�ial -`' ` "-- - ' ---------Depth of filter material-----------------"_ Remodeling and/or repairing (describe):____ --------"----------------------------------------- ---------- -- -- cer------h ----- --- ---------------------------------------------------------------------------------- ------------- -------------------- ----------------- ------- I hereby certify that I have prepare d this application and that the work will be done in accordance with San Joaquin County 1 'ordinances, State laws, and rqlesand regulations of the San Joaquin Local Health District. (Signed)_ ------------------------------------------------- (Owx+vm-and/or Contractor] 114*2 - ---•- (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 ` ""F- REVIEWED BY----------------- .:---------------------------------------- BUILIJING PERMIT ISSUED". = DATI_ ------ I -- ----------------------------- ------ Aaerations and/or recommendations-------------------------"-- ----------------"- - - -------------------------------------------------------------------- ---- DATE-- ---------------- -- ----------------------------- ------------------ TN ; r= =' --------------------- ------------------------------•-----------------------------------` y� ------------------------------ ----------------------------------------------------------------•--- ---- -• ---------- - ---------- - PERMIT No. *S`�-----•-- ISSUED------- ---(Date) FINAL INSPECTION. BY:----- .."V h------- ------------------------------------- Date F � — ---------------------------- SAN -------- -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California