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} ii■ s. �as..�o�nr ra APPLICATION FOR SANITATION PERMIT 4 � ~ (Complete in Duplicate) f 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. JOB ADDRESS AND OCATION---- `� d� l--------_��--.-------C ' �' - --- - -- ----------------------------------------------------------------- Owner'sA � -Name------------ }�-------------- ---M-6 �le� -- ---------------------------------------- - Phone 3 ------- Address-- - 1*- 1 - --- -- - ---------------------------------------------------------------------------------------------------------------------------------- Contractor's Name-----------------------_ �"'---- p_�_- ---- ---❑ --------- Phone--------------------- ----------- _ - -------- ---------- ---------------------------------------------- Installation will serve: Residence Apartment House Commercial [❑ Trailer Court ❑ Motel ❑ Other ElNumber of living units: Qo- �„ Number of baths Lot size_-_____�.� Number of bedrooms " �] "Water Supply: Public system 9 Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe Hardpan E] y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weff_----------------Distance from foundation--------------------Material ❑ No. of compartments=-----------------•------Capacity-----------------------Size--------------------------------Liquid depth--------------------------- Cesspool: Distance from nearest well----_--------------Distance from foundation--------------------Lining material_____---_________---_._ ------------- 4�S F (d� Size: Diameter------------------------------------ Depth- -- ---------- ------------ - - ` - - ---------------- .Priv Y: Distance from nearest well_-__________-----______-__ ________________________Distance from nearest building__________.____________ Distance to nearest lot line________________________ - ------------------------ - -Seepage Pit: Distance to nearest well----_------------------Distance from foundation-----------_--------Distance to nearest lot line________________ ❑ Number of pits-----------------------Lin.ing material-----------------------Size: Diameter------------------------Depth--------------------------------- .Disposal Field: Distance from nearest well-------___.Distance from foundation______w_�____Distance to nearest lot line-----d_r Number of lines_____________� Length of each line---______C�_^--------Width of trench_______!r_V e --------------- Type of filter material_j�&____k_____ Depth of-filter material------/_if__'_-------- Remodeling and/or repairing describe :________--___- -`---- l-#"=[_h, '-------=---------------------------- ----------- ------- ------------------------------- ----------------------------- ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- -----. t I 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. (Signed)---- - '--- � ----- --�_--------��- V ------ - --------------------------------------------------------- ---------(Owner and/or Contractor) By:--------------------------------------------------i------------------- ------- --- ---- Title _______ - - -- - - ------------- ----------------------------------------------------- -- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). i t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- � V_-_ DATE _----- ____ � REVIEWED BY----------------------------------------------- � ------------ -- ----------- ----------- DATE--------------------- ----------------------------------------------- BUILDING PERMIT ISSUED----------------- -------------- -- ------------ ----------------------•----------------------------------------- DATE Alterations and/or recommendations_____ ______________________. ----------------------------------------------- ---------------------------- ----------------------------------------------- ---••-------------------------------------------------------------;---------------------------------- , --------------------------------------------------- ----- - .- ____ - ----------------------------- PERMIT No --- _-- 155UED"_____._-- ---° _!_ SJ�__--(Date) FINAL INSPECTION BY------------------------ ----------------------------------------- - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street S - E5--9-2M 4-50 W-1639 Stockton, California a