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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. 549WV1_1!_� =04wm-kJOB ADQRESS AND LOCATION_.-._. yM -® " __ __________------------------------ _ Owner's Name---------�0---------- lam ------ e/. Phone-------�7- 7.5;5 �- W Address--------------------------- -�.�D.Q....- ! - � •------------ Contractor's Name--------------- ---------------------------------------------- --------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Ll Other ❑ Number of living units: © Number of bedrooms ® Number of baths AlLot size-----------____ ___-__° °�--C -o: Water Supply: Public system ❑ Community system ❑ Private ( ] i Character of soil to a depth of 3 feet: Sand El Gravel I-] SandyLoam ❑ 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_____2' __Distance from found tion__.___$____.Material_____________________________________ I J No. of compartments__________"1!__________Capacity---RP-G�� Size__ e?�, _ -----------Liquid depth_____4f -----_- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______________________-___________. ❑ Size: Diameter___-------------------------------Depth-------•-------------------------------------------- Privy: Distance from nearest well-----------------------------------_-------------Distance from nearest building______-__-----------__-__________________- ❑ Distance to nearest lot line________________________________________________ Seepage pit: Distance to nearest well----------------------Distance from fou ndation-------------------Distance to nearest lot line_______________ ❑ Number of pits______________________Lining material-----------------------Size: Diameter------------------------Depth_____________ -------------------- Disposal Field: Distance from nearest well_209--------Distance from foundation____ ____Distance to nearest lot I Number of lines-------t,3---------------------Length of each line-----------s'Q�`____-Width of trench______V_ _ -------------- Type of filter material�0&o_tDepth of filter material____ g -_________ Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------•------------------------------------------------- --------------------------------------------------------------._____»._._.____..--___________________________-________-____.-___-__-_____-______________________-__--________________--__..__________________________________ k ________________________•______________-__-______-__.________.-_______•_______________________._________________________________-_____________-___-___._-__----___________________..__________________________________________ hereby certify that I have prepared this appl' tion and that the work will be done in accordance with San Joaquin County ordinances, St la , and rulesAd regulatto`ns of h�San Joaquin Local Health District. (Signed)-- -----........ ------/---------------------------------------------------------------------------------------------------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title)----------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ----------- ----------------------- ------ -- - ---------- DATE `1 f �... ------------------------------- REVIEWED t ---------- ------ I REVIEWED BY--------------------- DATE_____- _-___ BUILDING PERMIT ISSUED---------- --- � / � .--�-C" --------------- DATE-- E !�' ------ ------- - Al�tions and/or r commendation _ �_ /� . --�___ __------------- s+ SeRn,s�c 1Y =y----------- ----� ------------------ ---- ------------------------------------------------------------------------------------------------------------------- ,�-� ' ------------------------------------------------------ --- --------- - ------- } f ---------------------------------------------------------------------------------------- ---------------------------------------------- PERMIT No.-!--?l----------- ISSUED--- ----------.-(Date] FINAL INSPECTION BY----------=--------------------"------- ----------------- 1 Date------------ ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639