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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) s. . I Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Loca This application is made in compliance with County Ordinance No. 549. ------------------- JOB ADDRESS AND LOCATION__- - ----------- s ( Phone_x-= / h -------- Owner's Owner's Name------�-- --- - ----------------------------------- -------- --------------- Address � -Ca-4_----- _ k' Contractor's Name__�S_�--i--��''�-�--�-- -�-4 h-�'-' ,----�--�-� ------ Court El M`tel ❑ 'O,Iier"❑ "------------ ------- --- Phone------------=-- Installation will serve: Residence �partment House E] Commercial ❑ Trailer Number of living units: . Number of bedrooms W ' Number of baths [2Lot size--�a Water Supply: Public system F-1Community system ❑ Private ®� Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Lam El Clay Loam C1 Clay ❑ Adobe Hardpan El TYPE OF INSTALLATION. AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f a e d rl3 C . , J/ Septic Tank: Distance from nearest•wefl__ ____________Distance from foundation___1________" ---.Materia--___--------------------- �f Capacity- ,Cesspool: a acit -----Size �� •_ � -�1i_Liquid depth-�2 ------------- LL�� No. of compartments-______C-------------- P y ---- Lining material------------------------------------- El Distance from nearest well__-""____________Distance fromtfoundation____"_.______ + ` ❑ Size: Diameter-----`------------------------------Depth---------- `----- ---------- --- ------------ Privy: ---_------Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-------------------------------------- . l Distance to nearest lot line-------��----------------------.------------ Seepage_Pi}; Distance to nearest well-_-__8�`1____.___Distance from foundation____70�----.Distance to nearest lot line___�f_----- h L_____"_-- Linin material Diameter"_--` ----"-"-.Depth__ --_S ------------ Number of pits _ g ' �' 'Distance from foundation _-�--Distance to nearest lot Disposal Field: Distance from nearest well_'_ l ®s ' Length of each line---0;—)---�_ _..Width of trench----------------------------------- Number of lines________ �_"_r_�_________ __ •. Type of filter material-/ Z-y- �� Depth of filter material-__-_ _______- Remodeling and/or repairing describe):__le,_�o-----T-P lfl �' ,.a►► -------&-- kit. 72*4-OCR ------ ----- --- ---------- ------ ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County k 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) (Owner and/or Contractor) a* ------(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 ' ---------------------------- ------------------------ ------------ DATE__ —---------------------------------------------: APPLICATION ACCEPTED BY---- DATE------ -�'f REVIEWEDBY-----------------------------------�`---------------------- ----------------------------------------- ---- BUILDING PERMIT ISSUED------------------------------- - ----------------- - - DATE-- �- _----------------------------- - Alterationsand/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- " ------------------------------------------------------------------------- ------------------------------------------------ -----------------------------------------------------------------•------•------------------------ y -•---------------- } ----- - ----- ! -- ----1 ------------`---------]------------------------------------------------------------------------ - ------------------------------- --------- ----------------------- - - - Q PERMIT No. __ "-°z"--- ISSUED___ ""-- --- ---- --- `� (Date FINAL INSPECTION BY:___- ""-- A "�� , Date ----------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-550 W-1639