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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 �r � ------f-��12 s ---------------- - "U - ©--�5,Q_ Phone----------------------------------- Owner's Name-------------------- - - - --- - ------- Address //;/& S. '- �- - `� ------------------------------------------------------------------------------------- 1_�s--------------- Contractor's Name------------�-�'-•`----�='-D•-'•-----�-r�-tS'v--�1,1-------------------S-�C=-- ---------------------------:-- ❑ Phone --------------------- ( Apartment House ❑ Commercial Trailer Court ❑ - [{ fir I- o Installation will serve: Residence -�-r Number of Irving units: '❑ Number of bedrooms � Number of baths � Lot size---------- ----------- --- ------ 'E • '1 Water Supply: Public system Community system ❑ Private Q Character of soil to a depth of 3 feet: Sand Gravel El Sandy Loam Clay Loam ❑ Clay [IAdobe E]- Hardpan L] 5 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic ank: Distance from nearest well-- --.Distance from foundation-__-_��- _-__.Material__.. •_________________________________________ q No. of compartments__-_----__�_ _Ca aci ��__Size Kr f------Liquid depth----------�'- -------- f� Capacity ------- " ----- . Cesspool: Distance from nearest well---------------- Distance from foundation___--- ___--_-_--_-Lining material____--____--- --__ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: -------------------- -----------------------------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_-____-_---__---- Number of pits----------------------Lining material-------•---------------Size: Diameter-----------------------.Depth------------ ------------------- El Disp s FieU: Distance from nearest well---��'_^'_4_-Distance fr rr�-f undation___-_ d ____-Distarice'to nearest 1ot line.- Number of lines------------�.&M-ZO------Length eF line,S /f10 ' Width of trench-------- of filter material_ --------------------tDepth of filter material____-- 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, Stat law and les anWreguiations of the San Joaquin Local Health District. / (Owner an / r Contract ) (Signed "t ------------------------------- [O d o' or stem in relation (Title s {Plot plans, showing size of lot, location of Sy on+o wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY DATE----------- - APPLICATION ACCEPTED BY REVIEWED G ---------------------------------------------------- DATE---------------------------------- --•---------- BY-------------------- ------------------------ ----------- ---- -'- - BUILDING PERMIT ISSUED------------------------ -------- ---------------------------------------------------------------- DATE------------------------------------------------------------- } Altera+ions and/or recommendations---------------------- -------------------------------- ---------------------------------------------- i ---^---•------•---'---------------------f-----------^- ------------------------------------------ ----- -- -----------------------•---- -------I-------•--; ------- 'O c ------ T ;6 (Date) FINAL INSPECTION :--- --ISSEPERMIT No.- p D ` Date.------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=109