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APPLICATION FOR SANITATION PERMIT b (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. l�(Y�7`-> Sr l;- i -- JOB ADDRESS AND LOCATION_ : 444,,W/ Owner's Name__ ----------------------- - . Address--. Phone --------------------------------------------------------------- Contractor's Name--" t • ----1------------------------------------------------------------------------------ --- -�" 0*^"V---- • Phone-47 will serve: Residence Apartment House ❑ Commercials � I Number of livingunits: Number of bedrooms Number of baths railer Court ❑ Motel ❑ Other ❑ [I Lot size---- � / Water Supply: Publics stem -------- - ------------------ Y Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank`or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- .Distance from nearest wel!___ �Distance from foundation------ No. of compartments--------- "/__" M ---- - --- ______ - Ca acitY--- 47-4--- Size---- C_-x.31----Liquid depth---- --- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______--__"-_ ❑ Size: Diameter--------------------------------------Depth- - Privy: D.istance'from nearest well ❑ Di - Distance from nearest buildin stance to nearest lot line---_-----" -- g -------------------------------- �, eepage Pit: Distance to nearest well El ______________________Distance from foundation-------------------.Distance to nearest lot line-------Number of pits______________________Lining material_____-___ _ ______"___ Size: Diameter--=:--------" .Disposal Field: Distance from nearest well----------------- -------""Depth"-___"-""`-_"-"_"""""_------ _Distance from foundation___________________Distance to nearest lot line------- Number of lines---- _----------Length of each line------------------------------Width of trench ________- -"-_-""_ Type of filter material_ ___-__---__-__-___-___Depth of filter material___ _ - ----------- Remodeling and/or repairing (describe):____________________----_ - ------ ---------------- ------------- a --------------------- - . •-------------------------------- --------------------------- ---- --- -- I hereby cerfify that I have prepar..ed this application.and that the work will be done in accord-ance wi--th San- ----Joaquin C-ounty----- ---- -- ----- ------------------ ---- ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----n. 01 -- - /o Contractor) -------------------------------------- ----- ------- Title + (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., musf be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______________ - --------------------------------------' " --- r -�---- ----------------------------------------- DATERFVIEWED BY ---------- BUILDING PERMIT ISSUED---------------------- ------------------------------ DATE_-------------------------------�---------�-- ------------------ -------- - -- 1 �- - -- """Alterations and/or recommendations:___"_______-_-_-_-"-- ------- --------------------- --------------- DATE.______ ____,"-""_"_ __ __ ---- ��----- ------- ------------ ----------- P---1.x - ------- ---- --------------------------------------------------------------- �Z ------- ----------------- ---- - •----- - ----------------------------------------------------------------------------------- ---------------------------- ---- -- J ---------------------------------------------- ` PERMIT No----- -------- --�- ISSUED------ � ---�`/ ------------(Date) FINAL INSPECTION Date_ ' `°` ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street W=1634 Stockton, California S