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r APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 1 - ._ Application is hereby made to the San Joaqu'_in Local"Nealth".District for�a,',perm�it to con u Xct and�ns+all theme wyorkherein described. This application is-made-in,ccmpliance�with'County'Ordinance`No:549 JOB ADDRESS AND LOCATION_____ ________________ - 'l " `-= _ - one ----- € Ph Owner's Name==----=----=------_— = _ �Y------- Address Y Address_---- ------- Ph C ' one--Other Installation Name r= ( -.1 Installation will serve: Res dente�Apartment-House ❑ Commercial ❑ 'Trailer Court ❑ Motel ❑ ther ❑ -----•-------------------- ---- -------- Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ of size___________________ r (� Water Supply: Public system A Community system ❑ Private ❑ \3 Character-of soil to a dep+h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobeA Hardpan-0 t \1 TYPE OF INSTALLATION.AND SPECIFICATIONS: f E (No septic tank or cesspool permitted'if public sewer is available within 200 feet:] Septic Tank: Distance from nearestrwell_________________Distance from foundation-__ _------Material_-_______-_____-____________--__________________ ❑ No. of-compartment Capacity Size Idw _----•------------Liquid depth------------------------- Cesspool: Distance from nearest well________ --------.Distance`from'foundation=�_-- --_-------�ining�m�tei ia-----------------------------;� ❑ Size:-Diameter-- _ " ----Depth_ , — _ . "•� -------------- g---------------------------- Privy: Distance from nearest well______________________ _________ __________ Distance from nearest,buildin l ❑ Distance to nearest loft'line-----------e----------`----------------- ----- r_----_ t Seepage Pit: - �--Dis+ance-to-nearest-well_-3 -=Dishance ff�m,fo'dafion___ Dis jan�a to nearest lot lin!___ _- `,. Number of its---(T Lining material----�1.1�Ck`�sJ-s-_Size: Diameter----&4-------------Depth__ 0-------------------- Ip -------- D.isposal_.Field:. .-Distance from nearest.well--______________.Distance:from�fqundaiion_______________a�..Dis:apce,to_nearest w-_. —� Width of trench r ________Length of each line------------------------------ ❑ ,Y Number of lines_________________________ g Type of filter material.------------------------Depth of filter material__________----________ Remodelin and/or re airm describe----------- --=-- fi g � } i = ------ ------- 9 p ,l .e .� -------------------------------------------- g (describe): -------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, s, and rules and re96' tions of the San Joaquin LocaHealth District. y. C and. Contractor) 5i ned ---j------- ` - v, _65 1=6 l__ (Owner an j� ftfk.' /!_' --------------(Title)- r�.'.fLt ` By:=---------------- ft ' ----------- / (Plot plan showing size of lot, location of system in relation to ells, buildings, etc., must be filed ith this application]. i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__-- _____ ----- - ----- -------------------------------------- DATE------ �--- F REVIEWED BY------------------------------------------------------------------------------------------------------------ DATE ------------- BUILDING PERMIT ISSUED---------------------------------- - DATE------------------------------------------------------------- 4>4 Alterations and/or recommendations:___________________ __� t✓ ----------•--------- ---------------- ----------•----------------------------------------------------- ----------------------------------------------------------------------- - I , - -------------------------------------- __�------------- ate DFINAL INSPECTION BY:._--- ------__-- ----- PERMIT No. ------- ISSUED --1------ 7 Date-------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ( 130 South American.Street - Stockton, California . y ES-9=2M 9-50 W-1639