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APPLICATION FOR SANITATION PERMIT (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. i JOB ADDRESS ANp LOCATION_ _._____ 3 - T -------------------------------------------------------------------------------- 4 Owner's Name ------------------------------'------!=�- ----- !_' v- one a Address-------- " Contractor's Name _ - -------------------------------------- Phone ---------------------- Installation will serve: . Residence ❑i Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ g ❑ of size..lf`� �f G------------------..........of living units: Number of bedrooms Number of baths L _____ Water Supply: Public system A Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2' Hardpan ❑ W I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public'sewer is available within 200 feet,) /� , f -- - Ca aci _ -/-------,MateriaLt�:�'�,rs Septi. Tank: Distance-from nearest wefl__,�...._--_Distance from foundation.__ No. of compartments--_____ ..--. q ty- aa-0--_____.Size_ • X�"�._.Liquid depth 0--- -- --------- Distance 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-.--•------------- ------------------ Seepage Pit: Distance to nearest well___.. /� � y ________Distance .f m,f �ndation.__�l�--_�.___.Distanc�� to nearest lot line_._._ --___-- Number of its____ P �o�'` Lining material. Diameter, �_._.Srze: -_._ Disposal Field: Distance from nearest well____________ ___Distance from foundation---/0-------- -Distance to nearest lot line__.-,.x�+ Number of lines------ ----------•--- ------•---Length of each line-------' Width of trench_.2.R.'----------------------- Type of filter material, ............ pth of filter material__Z ---! ------- Remodeling __ --Remodeling and/or repairing (describe):___.__-_- � ------- - _ ------------------ ------ ---------- -•---- ------- -- -------- -,------•--- - ------ ------ --- -- - .tee.. ----- -------- •-- - -- ��:- / -- -----------------------•---------------------- ------------- --------------- --- - i -------•--------- ------ ------------------------------------•------------------------------------------ -- -----------------------------------------------------------------------------------------------------------------------------------•------------------------ I I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, St laws, a . rules and regulations of the San Joaquin Local Health District. I (Signed)-__._-- � __---�� _--.x--)-- ----- --------------------- --------_--•--(Owner and/or ontractor) , BY Title.- - t r .= .: -- ----------------------------- ( ) _ ( P 9 g PP n. Plot plans, sho m size, f to oat"on of s stem in relation to wells, buildin s, etc.,•must be filed with this a lication. # ' FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED BY------------ ------ �---------=� .� DATE � r REVIEWED BY ------------------------------ ------------- --- DATE --------------- UILDINGPERMIT ISSUED---------=------------------------------------ -----------------------------------------------------! DATE----------------- --------�- --------------------- Alterations and/or recommendations_______________________ _ ------------- -•---- �$ 1 i 'rr------ -1 r rs"" c - --------- -- ;„ , x --------- ---•--------------------- ------------ --- rf�. �J"` -C &d, " Vic.- aa�,ra,� e; C tv- ------- --------- --------------- ----- �1 .mss.^•'"- PERMIT No'T �-X ---_-_ ISSUED------- 7 3 -__-(Date) FINAL INSPECTION BY:----------- Date---------- - ------r--��-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ;-9-2M 9-50 W-1639 // 1