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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) App kation is hereby made to the San Joaquin Local Health District for a permit to construct and install work h� esc3bed: This application is made in compliance with Co my Ordinance N . 549. the JOB ADDRESS AND LOCATION_____ .- _ .,, �. Owner's Name Q -?_ ------------------ Address------ �� /O C ---- -Phone------------------------------------ Contractor s Name---b-AVO --- - ------------------------------------ Phone---f77)07 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other � Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size Water Supply: Public system ❑ Communit s stem Y y E] Private�- ___________________________________ _______________ Character of soil to a depth of 3 feet: Sand ElGravel ❑ 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 Y-a---�Distance from'foundation____--______ -9-� No. of compartments_____ _ // // ��-Material__ ,ry '�,------------- ----. f Capacity �f - --------Size-- --AF----- Liquid depth_---/Xd-_ Cessp❑ ool: 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 foundation--------------------Distance to nearest lot line__-______________ - . 5�_ . __ Nurriber'of pits__ Lining•mate ria l-- -- Size:-.Diameter _�:.___ .Disposal Field: Distance from nearest well r � � _-_Distance from foundation___________ _______Distance to nearest lot line________________ Number of lines----------- _ -_____Length of each line_____��O E f ------.Width of tTench- -----2V Type of filter material Ay' �/�t____--Depth of filter material_____�,c�.-1''_ Remodeling and/or repairing (describe):-_ r t2�-------- i?FJ ----------------------•-------•--------- -- "� --------------- -- -------------------- -------------------------------- ' 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 rules and regulations of the San Joaquin Local Health District. a • (Signed)-- -tf_k' - ------ ---------------------------------------------------------------------- ------ (Orarrd/or Contractor) �y' {: �- - "aeX-- ------------------ -- ------------------------------------ - - - •----------(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----------------------,........... _�-____/ REVIEWED BY ! — DATE ; ' - ------------ - ----------------------------- DATE ------------ -- - . BUILDING PERMIT ISSUED - ---- ------------------- ----------------------------------- - DATE---- Alterations and/or recommendations________________________ -s -------------------------------------------------------------- .` -------------------------------•-------- •--------------------------------------------------------------- -------------------- --•------------------ PERMIT No. `-d------- ISSUED--------_-_7 . ------(Date) FINAL INSPECTION BY------ ----- --- ---- Date- - - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1539 Stockton, California