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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 AND LOCATION___ _1,e L i- Owner's Name_____ ____ ------ 4 --- -- --- -- ---- Address___.6 /_,//----- � _ one - ----------- ---- Contractor's Name______ _ +_--_ f�L✓[/.! t ------------- -- -------- Phone-9 ______ ----------------------- ---- Installation will serve: Residence' Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ :r} Number of living units: I Number of bedrooms [/ Number of baths Lot size_____ { Wa+er Supply: Publicsystem ❑ Community system Private �1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan F TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . Septic Tank: Distance from nearest well--- _f Distance from foundation_____ _ No. of compartments--------- CepacitYLesspool: -C-----Size---t-:IY 54-----Liquid depth---�4 Distance from _ -- nearest well_________________Distance from foundation_________________-_.Lining material--------------________- ❑ Size: Diameter Depth - ------------------------ -- :Privy: Distance from nearest well---------------------------- Distance from nearest buiidin g ------------------------ ❑ Distance to nearest lot line______________ tt --------------------------------- - Seepage Pit: Distance to nearest well------------- Distance from foundation------------------- Distance to nearest lot line---------- " ❑ Number of pits Lining material-----------------------Size: D eter-----------------------.Depth-------- Disposal Field: Distance from nearest well___J_O-_4_-.Distance from foundation_-__ _ 117------Distance to nearest lot line__�1__l_____ Number of lines_________ __ __!� Length of each line---------- $"_-(__----_-Width of trench------�Y_''-_--_-----_-_--_ Type of filter material-- it • ,��------- ------Depth of filter material____f�_---___-•- 'Remodeling and/or repairing (describe) _-__________----_ --------------------------------------------------- 1 - • -------------------------------------------------------------------------=----------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- I. --- - - - ------------- ---------- I hereby certify that I have prepared this application and +hat +fie work will be done in accordance with- --S-an- --Joaquin--Coun- -ty ordinances, State laws, and rules and' 'regulations of the San Joaquin Local Health District. $i ned ---------------------------------------------------------------- By: dfor Contractor] - { ] -- (Plot plans, showing size of iot, location of system in tela+ion to wells, bui .ldings, etc., must be filed with this application] � f FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY___-_______._---__--_-_ REVIEWED BY �. / ----------------------------------------- ----- DATE--------- 1 ------------------- BUILDING PERMIT ISSUED = DATE------------- --------- -- -- terations and/or recommendations - - ---------------- --- ------------ DATE---------------------=-------------------------------------- - -------------: �___________________ ------------------------- -------------- --------------------------------------------------------- ------------ --------------------------------- ------------------------------------ - ------------------------ / ------------------------------------------------------------------------------------------------------------------------------- PERMIT No(p___,7,3-------- ISSUED---___ -- --]�`1j�.1� (Date) FINAL INSPECTION ---------B--Y---�:_�_ __�e�-.�- .� -------- - - --- ------- Date a ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES--9-2M 9-50 W=1639 Stock+on, California