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�3 a 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_____ �j f - ., --- --------------------------------- . / --------C-0------_ Owner's Name ------ _ • ---- '------------- Phone----------------------- --- �------------ ---- ------------ Address--- - -- s-------�� "------------------------------------------------------------------------------------------------------------------------------------------- -Contractor's Name---- _______________________ Phone___ __7_ __ -Installation will serve: Residence ❑ Apartment House ❑ Commercial XTrailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths Lot size-___ _ __________________ Water Supply: Public system Community system � Private ❑ Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [:] Clay Loam E] Clay E] Adobe Hardpan El TYPE OF INSTALLATION AND SPECIFICATIONS: O� (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) v a ' Septic Tank: Distance from nearest well- '"'�___-Distance from foundation_____________-.Material---_��__ _ ____4_ _________----------- - h \ No. of compartments______ __ � �__!�_.�`+� Capacity____ �_�________Size_� ___��►t Liquid depth-___ -►------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 171 Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------_------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line------------------------------------------------ Seepa e•Pit: Distance to nearest well---!—_------Distance from fo ndafion____ L+ _____.Distance to nearest lot I'sne_--�____ Number of pits------1.1----------Lining material__ _____________Size: Diameter-----_ ,r,° Dep th___ -?'___________________ DisposalIField: Distance from nearest well------------------Disfance from foundation----,j_0------_.Distance to nearest lot line__,_ Number- of lines._--_:-._ - y _______. --Length of each line_- -_- x - �c Width of Trench____„, _ __._. _____ ° Type of filter mate�ial__11------ Depth of filter material-------I_<r _______ -Remodeling and/or repairing (describe):------------------- ----------------------------------- --------------------------------------------------------------------------------------------- ------------------------------- ----------------------------------------------- ----------------------------------------- - ----------------------------------------------------------- - -----------------------------------------•-----------------------11 - ---------------------------------------------------:------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------- 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 regulations of the San Joaquin Local Health District. i (Signed) .- _°-- P�*_ -------------------------------------------------------------------V--------(Qwmwmwd/or Contractor) �Y� ----------=--------------------------------------------•-=---------(Ti+le} ------------------ (Plot plans, showing size of lot, location'of system in relation to wells, buildings, etc., must be filed with this application). LEtPEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- - -------------------------------------------------------------- DATE------- ------------- REVIEWED BY = - - - DATE ---- -- ------------- BUILDING PERMIT ISSUED ---'------------------------------------------- ------------------------ DATE Alterations and/or,.recommendations:-- ----- ---------------------------------------------------------------------------------------------------------------------- i k ' // ----- -- -- ----- ------------------------- �. PERMIT No.._-.��_p________ ISSUED_--3_'�`-F'__"-�--L-_________-{Date] FINAL INSPECTION BY______________ ___ Date------------------------3-- -- 3 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Sock+on, California ES-9-2M 9-50 W-1639