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APPLICATION FOR SANITATION PERMIT 7 e (Complete in Duplicate) Application is hereby made to the San Joaquin Local health District for a permit to construct and/insfT.11 the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION - 1L� e r� ---------------------------------------------------------- ----- --- -------- --- ---- Owner's Name_ � _�_ -------------------------------------------------- Phone_-------------- Address.------- ----�-- - - -- '41 7 Contractor's Name------- - "`"-'- ------- Phone---- - Installaton will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other 11Number of living units: [ Number of bedrooms [ ] Number of baths [ ] Lot size----0 _ -----F-----*•-0----------------- Q Water Supply: Public system �ommunity system ❑ Private ❑ �.l Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan [] I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) '� _ ------ - i ..,,// ,Distance from foundation____1..�1 ___.__.Mat tial -�"�____ _ _________ - Septic Tank: Distance from nearest well___I1� ._ __ pp --- --- No. of compartments-____`�'o'e- _e_Capacity__ --F Size____. _ 1____Liquid depth___s.5-___________ Ir Cesspool: Distance from nearest well________________Distance from foundation--'________________Lining material_____________________________________. ❑ (*4' Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well________.______________________________________Distance from nearest building_______-_-----_______-____________----___. ❑ Distance to nearest lot line________________________________________________ I Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- to nearest lot line_______--_.____-_ ❑ Number of pits_-'-------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- D - •---.----- ,�/,7^ —istance from foundation____�� Disposal Field: Distance from nearest well_1_Y-{�_f'�U' _______________Distance to nearest lot line________.________ Number of lines___ Length of each Iine__ ___�____ Width of trench-______ f` Type of filter mai terial____ __ + Depth of filter material--- ___ ________-__ 3 � 3 - Remodelingand/or repairing (describe):----------------------------------------------------------------=-----------------------------------•-------------------------------------------- -----------------------------------------•------------------------------------ ----------•---------------------•--------------------------------------------------------------- ----------- •---------------•--------------------------•----------------------------------------------------------•---------------------------------------._..---------------•---•-------------------- ---------------------------- ---------------------• ---------------- ---------- ------ 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]____ (Owner and/or Contractor) ------------------------•-------------------•---------------------------------------------------------------------------------- By:---------------------------------------------•------------------------------------------------------------------------------------(Title)----------------_--___.-------------•------•-------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY I ` APPLICATION ACCEPTED BY---------------------- --- -- --- DATE---- -_ .--------- --- ,/ -- - ----- - ----------------------------------------------- REVIEWEDBY--•------------------ ----------- ------------- ------------------- -------- DATE----- -=------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------ ------------------------------------------------------------------------------------------------------------------------------- ---•------------------ -------------------•------------- ---------------•----------------------------------=------------------------------------------------------------------------------- -----------------------------------------------------------•-------------------------------------------------------------------------------- ,E ----------- - ------•------------------------------------------------------------------------------------------- ----- PERMIT No !- --. hSSUED__ t--------------------------Date) FINAL INSPECTION. BY:-------------- -' ------------------------------ Date_ --O--'---4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street r_ Stockton, California ES-9-2 M 9-50 W=1639 i