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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 L.Of ATION .�`~ j� l_G� 1-6e -----�=nC.(��------------------------------------------------------ Owner's Name--------- "" 4C.f_ Aj - r�/�,l�i�'"�Q�"� ------------------------------------------- Phone----------------------------------- ----------------------- -----------------------------------------------------f Address----------------------------------------------- ----------------------------------------------------------------------------------------------------•-----y------------------------- Contractor's Name------------------------------ -- ' __-_---_-. Phone-------------------- Installation will serve: Residence [!(Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units: d Number of bedrooms ID Number of baths V Lot size-------- `�x___t - ----------------------- Water Supply: Public system 12/Community system ❑' Private ❑ P Character of soil to a depth of 3 feet:.' Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan p ❑ ❑ Y ❑ Y l� Y ❑ ❑ p ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �r Septic Tank: Distance from nearest well-------_-_ --_Distance from foundation-----�P---------Material..____��-`__------�---p- No. of compartments---_-_--_.__ ______--Capacity_ D--7---__-Size-_ -_ ---___.Liquid depth-__-.4E----------------- Cesspool: ----_-_---_ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------------__-------_-____--__-----: ❑ Size: Diameter-------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__-_-----------------------_-------_-----. ❑ Distance to nearest lot line------------------------------------------------ l Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---_-_______----- [] Number of pits----------------------Lining material-----------------------Size:'Diameter-----.-----------------.Depth--------------------------------- Disposal Field: Distance from nearest well------------------Distance from foundation-------/�o---------Distance to nearest lot line----------------- of Number of lines-_-�_-_.__Y'" --------_----Length of each linef'�`:� -'------- _.Width of french---- i-__- ----------------- Type of filter material__t�"_-Depth of filter material-------P00`1-----_- i Remodelingand/or repairing (describe)----------------------- ---------------------------------------------------------------------------------------------------------------------------------- R 1 -------------------------------------------------------------- "------------------------------------------------------------------------------------------------------------------------------------------------------------ I he rtify that I have prepared th4� 11,cation andthat the work will be done in accordance with San Joaquin County ordinances, a e laws, and rules ands egulaf the San oaquin Local Health District. (Signed)--- - " '`-'�----------------------------------------------------- --------- - ------------------------------------------------ (Owner and/or Contractor) BY' --- ------------- ------------------•----- --------------------- --------------------------------------(Title)------------,--------------------------------------------------- I (Plot pi s, s owing size of lot, location of system in relation to ells, buildings, etc., must be filed with this application). -i. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ � ---- -------- DATE : � a - .3 /---------------- % REVIEWEDBY--------------------------------------------- --------------- DATE------------------------------------------------------------ BUILDING A BUILDINGPERMIT ISSUED------------------------------------- =--------------------------------------------------------------- DATE------------------------------------------------------------- ' Alterationsand/or recommendations----------------------------------------------------=-------------------------------------------=-------------------------------------------------------------- -------------------------------------------------- ----------- -------------------------------------------------------------------------------------------------------------------------------------------------- -------- ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------•----------------------- ' --- ------------------------------------------------------------------------------------------------ --------------- VZ �,�. PERMIT NaV - . ISSUED P 1 (Date) FINAL INSPECTION BY: ---- r------- ------------------------------- Date------ ------------------------------ Date------ ----------=-� f(a� ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639