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APPLICATION FOR SANITATION PERMIT A ?* J . � (Complete in Duplicate) 7 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. ii JOB ADDRESS AND LOCATION Owner's Name------� '� ----------1914946--of----- Phone-- _(4 --------- Address. -- +-----r► 5 -.'- � ----------------------------------------------------------------------------------- Q Contractor's Name---------- EA- ?�►�+►- i ---------------------------------------------------------- Phone--57---f XQ_�'_'----------- Installation will serve: Residence X Apartment House ❑ 'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :[Z Number of bedrooms k Number of baths I Lot size---42-__e— -------------_________—.:__-___.-_.__.,� Water Supply: Public system ❑ Community system ❑ Private K Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material ________________________________________________- \ Effj,�&$ 19 No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth----------- ------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- EJSize: Diameter--------------------------------------Depth---------------------------------------------------- .Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F-1 Distance to nearest lot line -Seepage Pit: Distance to nearest well---------------------- from foundation--------------------.Distance to nearest lot line_----_-__________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------------.Depth----_---------------------------- Disposal Field: Distance from nearest well___*__.Distance from foundation_ldr------------Distance to nearest lot hine__fQ!----- Number __Number of lines_________ __----------------------Length of each line_____s4W --------------Width of trenck-10__-010-------------------- Type of filter material-l-k!A-______Depth of filter material-----/.�!!------- y Remodeling and/or repairing -describe)----- I'11?� ------------------------------------- 7_ .1 � ---- ------------- ------ ------------------------------------ -----------------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------•---------------------•------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.' )7f_)_9,A0& {Si9ned} � - � Kp- i�I Contractor) ---------- ------------------------------------------------ (Title) lMAl (Plot plans, s ' e of lot, location f system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTS BY- - DATE--/- ---- ----------------------------------------------------- REVIEWED .S'TJ BY------------- ------- ----------------- - ------------ DATE__"`---' 'I------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------- ------------------------ DATE--- ---------------- Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------- -----------------------------•---------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------•------------------------------------ ------------------------------------ PERMIT No.____-�7i ------- ISSUED.__ "'` T S ------------_(Date) FINAL INSPECTION :---- _ _- _. ____ Date ----- ---- --- -- - -- - __ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639