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f Or r. Ply APPLICATION FOR SANITATION PERMIT 0�r (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. rr JOB ADDRESS AND LOCATION--------------- r.._--, � f/-------- ----Ha --------------------------------------------------------------- Owner's Name-----------------`s.f-l_._42-1 _e j6�L� ------ --------------------------------------- Phone----- ` �~a-7;� Address- ------------------ `----------------------------------------------- r +. Contractor's Name----------------------------- ------------------ ----------------------- ----- Phone----------------------------------- Installation ------------------------------• -Installation will serve: Residence X Apartment House ❑ Commercial Trailer rCourt ❑ Motel ❑ Other ❑ Number of living units:. Number of bedreoms4*21 Number of baths Lot size--------� _✓ _/ p---___------------------ Water Supply: Public system x Community system ❑' Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ TYPE OF 'INSTALLATION AND SPECIFICATIONS: 1 l , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �! Septic Tank: Distance from nearest well-----------------Distance.from foundation-------------------.Material------4---------------------------------------- .. Q ❑ No. of corn artments--------------------------Ca Capacity ---Size-------------------------------_Li depth--------------------------- Liquid de P P y-=---------- - ---- q P Cesspool: Distance from' nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ElSize: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well_________________ ---------------------------Distance from nearest building-----------�f - -_- -__--,�� ❑ Distance to nearest lot line______________ _______________-____________---_ tW Seep a Pit: Distance to nearest well _______Distance fr foundation____---------------D' to nearest I�$. line---4______ Number of pits--------/-----------Lining material_D_4j__1k_C/T_Size: Diameter_____ ____________Depth_____!_ Disposal Field: Distance from nearest well_______ _____Distance from foundation____ 10-36_-_Distance to nearest lot line_- .- ---. Number of lines_______________ --Length of each line:_____s�_---------Width of trench--------- ________________ Type of filter material._!!j�_ _'__Depth of filter mat6rial_____1._? _______._ Remodeling and/or repairing (describe):-----= ----------------:11--1 ------—;4------ -----------•---------- ---------------- ------ t ------------------- -- /�-c�u ' ------------------------------------------------------------- ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-_�.-- ----------- ---•------------•-----------------------------------------------------------------------------------------(Owner and/or Contractor) By:-- ----------•-----_--------- ----------------------------------------------------------•-------------------(Title)---------------------------------------------------------------- (Plot plans, owing size of lot, locati n of system in relation to wells, buildings, etc., must be filed with this application). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -__ DATE---- (- �` S REVIEWEDBY.. ---------------------L--- ------------------------------------------- DATE-------- p3- a•----------------------- BUILDINGPERMIT ISSUED--------------•-------------- -------------- -------•---------------------------------------------- DATE---------_-�-- -•---------------------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------- -------------- ----------------------------- - 1 ------------------•--------------------------------------------•--•-------------------- ----------------------.-------------------------------------------------------- ---------------------------------------------------•-------------------------------------------------•---•-----------------------------------------------------------_-------------_.._.._.. .------------------- --------- -------------------------- --- --------------------------------------• ----------------------------...�...--------------------- ---Q -- -•-- -•-----------------•------------- PERMIT No------3_y-------- ISSUED--- --i'}_____________(Date) FINAL INSPECTION BY:--------- ----- -------------------- _ --------------- Date ------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639