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ti 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. JOB ADDRESS AND LOCATION______ ��7-___s' _ ---------_ -------------- --------------------------------------------------- Owner's Name ---- Phone Address-------- _Z- / -�� - -- ------------- --------------------------------------------------------------•--------------------- ------------------------------------ -Contractor's Name-------- Phone .Installation will serve: Residence�Apa tment House El Commercial ElTraiier Court ❑ Motel p Other ❑ Number of living units: �f Number of bedrooms j9 Number of baths Lot size_____; --- - - --- -------------- Water Supply: Public system 0 Community system ❑ Private ❑ / Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El' Gay El Adobe, Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or cesspool permitted if public sewer is available within.200 feet.) �. Septic Tan Distance from nearest well_/_----'__G�____'___Distance from foundation-------'Material __________ -------------------------- No. of compartments___:,-- ------Capacity_ QU------Size------ -------------------------Liquid depth-" V. esspool: Distance from nearest we11_________________Distance from foundation--------_________-.Lining material__----------_--____.__________- ❑ . Size: Diameter--------- ------------- -------------Depth--------------------------�;�--------- ------- Privy: Distance from nearest well_________________________------------------------Distance from nearest buildin• ❑ Distance to nearest lot line______----__ ` J Seepage Pit: Distance to nearest well------ --------Distance from fo ndation----� _._ __DistqrFe to nearest lot line--------_ l._ /'j_'� Number of pits-------1------------Lining material_ ---- Size: Di�ete --------f-f--------------.Depth__ f ! J ----------- -/ -� .. Dis osal Field: Distance from nearest wel _.Distance from foundation.______ __... ______Distance to nearest lot line-- Number of lines"____________�._- Length of each line___________ _ ------------- D Width of trench---_----_"- __-- --- Type of filter material-_ ' __------__ _Depth of filter material____----/------------ Remodeling and/or repai[ing (describe):____ ___ --------- _ "4 ------------ ------------------------------------I------w ------- --------------------I-- ---1--an ----------------------------------------- ------- ------------- --------------- - --------•---- ------- ------------ ---------- -- ----------- - ------------------ -- I hereby certify that I have prepared this applicati n and that the work wi be don in accordance with San Joaquin County ordinances, State la d rul ati regulao of f an Joaq in Local H th Dist , (Signed)- ' ) BY:--------" - ---- ----- --- -- -- --- -- --- -- � - caner a Contractor) c - --------------------------------------------------(Tlfle)-- (Plot plans, shows size of)ot, c ioq of Sy 'm in relation to wells, buildings, etc., must be filed with this applicatii FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -J0 - DATE li" ----------------- REVIEWED BY -- r ----- DATE - BUILDING PERMIT ISSUED---------------------------------- -- ------ DATE - ------------------------------------------- ------------ ------------------------ A+erations and/or recommendations___________________ ------------------------------------ - -- - – ' -- -- ----------------- ---- � ------ ------------ ------- a -- __f----- ------------------ ------ ---- --> --------- ----------------- PERMIT No--------']1__ -_-_- ISSUED__--_ � --�5_=-_-1------(Date) FINAL INSPECTION BY_____________�lL� !� - �j -------------------------------- ..T.Gl:4yt,�a �fl J Date 4p ``r X 2G/p SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ` �.. Stockton, California ES-9-2M 9-50 W-1634 _.Fa