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APPLICATION FOR SANITATION PERMIT I ,r� (Complete in Duplicate) ' j �� '' 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 Count y l H ante No, 549. L JOB ADDRESS ,a,N LQC TION •--- ------------------------------------------ Owner's Name_____________�__ -- -------------------------Address------- --------------------- Phone r 0 ------- Contractor's Name... .--- - � - ------ Installation will serve: Residence --- ' ----- ------------- -------•-- Phone----- ' -------------- Apar#men# House ""'"-------------- ❑ Commercial Number of living units. t Number of bedrooms ❑ Trailer Court ❑ Motel ❑ Oth ❑ Water Supply: Number of baths � Lot size__��s7 Public system [] Community system ❑ Private I1�0 --- -- -- -- --- ------------------------ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe TYPE OF INSTALLATION AND SPECIFICATIONS: El Hardpan ❑ (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well-___ Distance from foundation-______ i No. of compartments------------ ---------Material_____-__-- G ` -----------Capacity-----s30l9 _�5ize__._ -----•'�----------- Cesspool: Distance from nearest well ___ 45-X�`'`--+r----Liquid depth------- - _ ___-_Distance from foundation El materia!------------------------------------- ------------------- Privy: ___-____-_________""_ ❑ Size: Diameter-----"-""--_ r Depth_ ------ -- rivy: Distance from nearest wellEl _________________ . . f -_-______-Distance from nearest building Distance to nearest lot line------------ g___"_-_____-___""-- Seepage Pit: -------- Distance to nearest well__ ____ foundationL� ❑ Number of pifs-------_.__ ----Distance from ___________________Distance to nearest lot line ______-_______- --.-----._Lining material-----------------------Size- Diameter------------------------ Field: Distance from nearest well----- Number -""Distance from foundation_____ Dist Depth--------------------------------- Disposal �� r Number of lines___.._____.__ ______ """ Length of each line-__-__-_ ante to nearest lot line____"'-�"--- Q w 7� Wid#h of french - tf Type of filter materral_fi�J'�yDepth of filter material-__--J ! Remode�lin and/or repairing est abe]:__"•__-- -_" " t -` ... ._ a ,c _ -------- �— -------------------- --------°�-----ems - --- Yy - _�- - - ----------------- -------------------------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa uin ordinances, State Laws, and rules and regulations of the San Joaquin Local Health District. ---- q County {Signed}_:a'�1? , ------------- ` --- -------------- •-------- ---------------------------- ---------------------(Owner and/or Contractor] BY:--------------------------------------------------------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must beefiled with this application}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.- REVIEWED Y_REVIEWED BY----- z ----=------------ ------ ,. �'. ..� DATE " ---------------------------------------------------------------- ------------------- - BUILDING PERMIT 155UED-------------- - ------ ------------- ------------- --- DATE_---- ----'-�---�. ----- ---- ----------------- Alterations and/or recommenda&9-0tions:___;�.� ��j - "- D TE.____-" tr ' ----�=-- -- ----- �► - -A-$ t------+ r ------------------------------------------------------ - ------------------- ------ -------•--------------•-------•--------------------------------• ---------- -- ----- -------------------------------- PERMIT No.---_�/--7 --------- ------- ISSUED------ �r `) -�- -- -- FINAL INSPECTION 8Y:_____""_�[/- V - ----------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street , ES-9-2M 9-50 W-1639 Stockton, California