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APPLICATION FOR SANITATION PERMIT _, y0 (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 Courcy Ordinance No. 549. �S "7 --' 2A13--Io ��A. a ADDRESS AND LOCATION �j � AAAAW =4- S---s I Owner's Name----S--4 ---------.- LL- 4--k.-VMS;- Phone Address------------------- "� ' 8 -------------- s A` _ --------- --------------------- --------------------------------------------- Contractor's Name-----SID--1---- F --------------------------------------------------------•---------------- Phone-o --1 -0-9--------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Moteea Other ❑ 1 Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size-- _------- -i-o---------------=-- Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ElCiay Loam E] Clay El Adobe Hardpan] Ir TYPE OF INSTALLATION AND.SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material_____---___:________________-__--______________ ❑ No. of compartments--------------------------Capacity-----------------------Size------------------------------Liquid depth------------------------- 1 Cesspool: I 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------------------------------------------------ d F.,j i Seepage Pit: Distance to nearest well `_"_Distance f om foundation-____.Z_ __-__.Dista c��to nearest lot line._,-�_________t Number of pits------------ material____ XIC#X-Size: Diameter____ Depth------,��_______________ 4r----_.Distance from foundation_____��,______Distance to nearest lot line.__/G--__ Di posal Field: Distance from nearest well________ ��//Number of lines________________ Length of each line____---,, _____ ____-Width of french------�--7-----------------Type of filter material__��- k �---Depth of filter material____-a�Remodeling and/or repairing (describe)---------------� A----------------------------------------------------'--------------------------------------------------------------------------------------------------------------------------------- ------------------------------•--------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfaf ws nd r es and regulations of the San Joaquin Local Health District. ----'----------------------------------------------------------------------- Owner and/or Contractor) (Signed)------- gy=------------------------------------------ --------------------- --'-----------------------------------(Title)--- ----------------------- (Plot plans, showing size of lot, location o system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------------------\-O- --------------------------------------- DATE----------- - - ___ — REVIEWED BY--------------------------------------------------------------- -------- ---------------------------------------- DATE---------- -------------------------------- ----- -- - BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- --------------------------------------- - ------------ ------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 3 _______ ___------------------ / ________________ j PERMIT No.__�--=��--- IS5UED_____~��-=--r-�-�-�---(Date) FINAL INSPECTION BY------------ �` - - Date-----------------------�/--------- '.� / ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street b Stockton, California ES-9-2M 9-50 W=1639