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i APPLICATION FOR SANITATION PERMIT'' 77 / (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 LOCATi0N_.' ---'?-z/0-------tZ_4_c '--- --------- �r -------------- -------------------------- Owner's Name V------ -----------NV�--- ' --------------- IV ----------- Phone _ `7� Adress------ ----------- ---- -----�-�--�--�-=---------- ----------- ---------- - - ------------------------------ Contractor's Name---------------'--�----t-�........ �' - ------- ' _40-1 - ' '� - `` Phone - -_; Installation will serve: Residence ❑ Apartment House ❑ Commercial V -hailer Court ❑ Motel ❑ Other, Number of living units: ❑ Number of bedrooms r t❑ ❑ ❑ ❑ e- -� f3 /(1� Number of baths Lot siz Water Supply: Public system 9 Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam .El Clay ❑ Adobe ❑'j Hardpan ( TYPE OF INSTALLATION AND SPECIFICATIONS: i ++ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well_________________Distance from foundation_______._______ Material_______.__________ ------------------------------ ❑ No. of compartments--------------------------Capacity----------------------- _____------Liquid depth_-- ------__---- - Size=----------------- ---------Cesspool: Distance from nearest well_________________Distance from foundation__________________ .'Lining material----------------------------__ Size: Diameter Depth t Privy: Distance from nearest well_________________________ __Distance from neap rest buildin ' Distance to nearest lot line-------------------------------- ------------- g ' Seepage Pit: Distance to nearest well_____ '__Distancepfrom fo ndation__4_0--------Distance to nearest lot line----•�_4_ 19 Number of pits________ __ Linin mafierial_ _I _--k_ g - _ - �� Size: Diameter_ � f*r -------- -----3-0 Disposal Field: Distance from nearest well------- -_----Distance from foundation__t __�_-_-i -.Depth---- -----f / -Distance to-neares+'lot-line_______ G_-_- [ Number.of lines--- if ----------f------------------Length of each line---------eft_-____rf_--.Width of french_------ tl Type of filter maferial � ---Depth of filter material________ __•____,., Remodeling and/or repairing [describe)------------------ - T ---- -- --------- p pp - ----------- ----------------------------------------------------------- I hereby certify th4T 'n re aced this application and that the work will be done in accordance with San Joaquin County ordinances, State la, sd regulations of the San Joaquin Local Health District. ' (Signed)-------- a ; - ------ ---- �""�--------------------------------------------------------------------- I ------(Ow. .. Contractor By:----------------------------------------------------- --------- ---- ---- ------------------------------------------------- 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__,________.�- -_1- ----_----- REVIEWED BY------•----- ---------- ". {/{/ DATE ----------- -------------------------------------- ------------------------------------ DATE_-------------------------------- - ------------------------ BUILDWG PERMIT ISSUED ----------------------------------- ------ - - ----------- ---------- Alterations and/or recommendations___________________________ - ------------------------- -------------------------------------------------------------------------------------------------------------------------------------- ---------------------- ------------------------------------------------------ -------- ------------------------------------------------------- s --------------------------------------------------------- --- -------------------------------------- - - - ------------- PERMIT No----7.71--------- ISSUED------- / (Date) FINAL INSPECTION BY:--- -------- - ------- .S' Date �h � ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES--9-2M 9-50 WA639 Stockton, California