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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 4 Application is hereby made to the San Joaquin Local Health District for a permit to con ct and install the work herein described. This application is made in compliance with County Ordinance . 5 9. JOB ADDRESS ANp" CATION____ _ _ _ ` f --- ------------ - - Owner's Name---------- -----e /� ---------I-------= -- - ,/l-------------------------------------------------------------- Phone-5 Address------------------------- �j -- -------------------------------------------------------------------- Contractors Name.___-_ •---/--- u--�-:! - } 'T - -------------- ---�--�--��-`�--�---------� ��_ � .�_��_ Phone---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units_ Number'of bedrooms 9& Number of baths [Z Lot size___ ------------1 � ---•--------------------- Water Supply: Public system Community system E] Private E] jV Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe jN Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic�ctcesspool Prif public le � 0 feet.) Septic TankDistance from nearest is from foundation Material_________________ fy' ❑ No. of compartments--------------------------Capacity---------:------------Size------------------------•-------Liquid depth----------------- f Cesspool: 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__________________________-___-_:______-__-_-- w Seepage Pit: Distance to nearest well__________ __________Distance from foundation----L----------- Distance to nearest lot line_•��________ Number of pits__'_0_fAV-------Lining material__ _�_ ?-6X__Size: Diameter_ .'9_F----------Depth__R_&f___._ ` --------------- Disposal Field: Distance from nearest well------ _"_'Distance from foundatio __=Stir-----------Distance to nearest lot line___f__ - Number of lines--__ - y____-----------Length of each line___ __________77------- Width of trench____-,2 /4-%_______________ Type of filter material-45r----WC_tX_Depth of filter material-----a f Remodeling and/or repairing (describe) y ---------- -----------____ _____ ----------P----------------------------------�_?i 1 _: � � - ------------------------------------------------------------ ---------------------------------------------------------------------------------------•- 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 r4gulafions of the San Joaquin Loca ealth District. - s i ---j (Signed)---- ' -------- - ------ti-i---, ---- - ----------- - wrier an /a �ontrac r) 8 - i,1--1�'� __ _.�Q1---- --- w r Y� - = E = s-,t l --(Title)--------' -C. (Plot plans, showing size of lot, location of system in relation? weds, buildings, etc., must be filed wiihjhis application). ' r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --------` ---------------------------- ---------- DATE---f REVIEWED BY-------------------- BUILDING Y - DATE "`n --------------- BUILDING PERMIT ISSUED ------------------------------------------ _-----------------------------------------------------------------------------._ DATE--------------- Alterations and/or recommendations:-r=== --- ------------------ --------------------------------------------------------------------------•--------------------------=----------------------------------------------------------------------------------------------------•--------------- ------------------•------•------------------------------ ------------------- -----------------------------------------------------------------------------•._-----------------------••------ ------------------------------------------------------ ---------------------- ----------------------- PERMIT No------ _�_ ---- ISSUED----------------------------- ( ) -_______ Date FINAL INSPECTIONwBY:__,__-__Lr�_I/ ------------------------------------ _- --------------- Date -" ----- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street Stockton, California ES--9---2M 9-50 W-1639 � � �