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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. J / --"-- -- JOB ADDRESS AND LOCATION--_-3Z-/ -- - Owner's Name---- �==-------- ---------- ---------•- ------------------------ --- - ------------------------------ --------------- Phone------------------------------------ = --------- ----------------------- - -'fl ----------------------------- ------------------------------- Address------ Phone----------------------------------- Contractor's Name---------_____ ____._ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑- Installation will serve: Residence [AQ_ Ap ❑ Number of living units: ❑ Number of bedrooms jjj_ Number of baths Lot size------- ------------------------- Water - ------Water Supply: Public system ❑ Community system ❑ Private [I/ Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam El Clay Loam 11Clay ❑- Adobe [I Hardpan ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: C1J: 'C/1� (No septic tank or cesspool permitted if public saver is available within 200 feet.] - Dt -Material------------- ---- S • tic Tank: Distance from nearest we "_Cistance from foundation-__/C---_- --- iNo. of compartments-------- - �QSr' Li uid depth ---------- acitY ----_ ze---------- - fi ,sWr yr, Dstance from nearest well-----------------Distance from foundation-------------- -----Lining material------------------------------------- ❑ Size:sta e froncr--------------------------------Depth--------------------- ----------------------------- Privy: Distance nearest well------------------------------------ __________Distance from nearest building------ ---------------------------=------ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line----------------- 4 Size: Diameter Depth �'T�a ❑ Number of pits----------- --------Lining material Dispos I Field: Distance from nearest well__-�d_____.Distance from foundation,_ -----------------Distance to nearest lot line_ Number of lines_!__---e` ►r__--1-----------Length of each line:-B___ 0---s�Width of trench------- --- ---------- -___-Depth of filter material________l �t ' Type of filter material__�.r Remodeling and/or repairing (describe):------------------------------------------------•---------------- -- --------------------------------------------------•------------------------------ --- , - ------- ----------------------- --------- -- ------------------------ ------------------------------------------------ ----------------------------------------------- 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. Si ned �2=Ae),-_R� -----�- �------ .�� ------------------------------------------------------------ ___-___-(Owner and/or Contractor) { g ) ;.` ' le --------------------------------------- By:- ---------- ------`- - --- ------- -- - -------------- -- (Tlt ) } (Plot plans, showing size of lot, location of system in relation to wells, buildi� n� ggs. et�cµ mustbe fild with this application). FOR DEPARTMENT USE ONLY1 APPLICATION ACCEPTED BY__________________ --------------------- - DATE----- ! J�- DATE----------- REVIEWED BY I DATE------------------------------------------- ----------------- BUILDING PERMIT ISSUED------ --------------- - - ------------------------------------------------4---- Alterations and/o recomme datio � ' � � �i�I -��_!_��__�P__.--- �---�-��'"-__�P��-- Gir. kf,_ h'Q fM_12�4re _fi-.c✓;� c,� ---A-------- ------------------------- --------------------------------------- ------------------ --------- ---------------- PERMIT No. -- Date) FINAL INSPECTION BY--------------- --- -- -------------------------------- � --------- ISSUED: -�3 Y I 531- Date---------- ; � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W=1639