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1� APPLICATION FOR SANITATION PERMIT l \, (Complete in Duplicate) :c Application is hereby macle;fo 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 LOCS'J� /nl1�'15 ! *� ATION ---"' A------------- • - ---------------- evOwner's Name --------------;-------------------------- - ----- Phone --------------------------------- Addreanfr Name- -- ss r-•--------•--�---------------��-,� - j� Q�� - �, 1 ' - � ----- -- l----------------------------------- --------------------------- Phone------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size________________________ Wafer Supply: Public system ❑ Community system ❑ Private ❑ Character of soil to a depth'! of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay Y ❑ y ❑ y ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distanceifrom nearest well ----------------- Distance from foundation ------------------ ..Material ---------------------- - 1 ❑ No. of compartments ---------------------- ---Capacity ------------- ---------- Size ----------- -------------------- Liquid depth -------------------------- Cesspool: Distance from nearest well ----------------- Distance from foundation ---------- .____._-__Lining material___.____..._-___--- Size: Dia --------------_. PrivDistance meter------------------ --------------- Qepth------------------------------------------------- - y• ifrom nearest well ---- r7777= ---------------------- _Distance from nearest building ___-__________________-____---________--_, Distance fo nearest lot line_____________________________________________ Seepage Pit: Distance ao nearest well ---------------------- Distance from foundation -------------------- Distance to nearest lot line_______________._ Number of pits -------Lining material----------------------- Size: Diameter ------------------------ Depth ---------------------- ----------- Disposal Field: Distance from nearest welt ------------------ Distance from foundation -------------------- Distance to nearest lot line _-_______________ ❑ Number of lines ----------------------------------- Length of each line ------------------------------ Width of trench Type of fitter material ------------------------- of filter material_______________________ Re eling and/or repairing (describe):_-____ _ IWO Q - ----------------------------•---- Z {-------------------Z)); ` � --r-- %., 1l -' �'"t A.4 ---- � � . 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. " (5igned)_____✓ -----------/! ------ -- i�VC. i�� -------------------------------------------------------- (Owner and/or Contractor] BY:----------------------------------------------------------------------------------------------------------------- Title - --------------------------------------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, efc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ -------------------- -- -- ---- - DATE-_ �-�_�!_ - r - f f BUILDING PERMIT ISSUED__: ------------------- --•-------------------------------------- DATE 7 REVIEWED BY_____ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- ---------�---�-------------------�------------ --- ---�--- DATE --------- ferations an/or recommendafions------------------------------ --- �__ ___ v _ ---------- ---------------- -------------------- ------------------ -- - -' Yg-� -------- -------- ------ ------------------------- -------------------------------------------- ---- -- t" ------- ------------------------------------------------------------------ ----- i! __.__,___-.-------------- --.__________________ - ------------------- __------ .----------------------------------- -------------------------- ------------------------------------------------------ �6 `r PERMIT No--------------_---___--- ISSUED-- -_-- FINAL INSPECTION BY: ------------- Date ------------------------------ ---_----_---Date------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES -9-2M 9.50 W-1 639 Stockton, California a