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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 LOCATION_____l1_;o 11------�.---N �� ----------- Owners Name---------444-e...... #�1le -------- - -----CtJ?f__ i! r pfd� oPhone 1 yAddress-------- -------- . --- Q f7 ' i -----6 Phone Contractors Name Installation will serve: Residence 3L Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ® Number of bedrooms E�Number of baths [Z Lot size_____ w--X_,l4 ------------------------------- Water r Water Supply: - Public system 9,.Community system ❑ Private ❑ Character of soil +o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe El Hard pan ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted If XPIC'__ blic sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ Distance from foundation-__/O_________.Material I - !! =- '�'�°�-------.- No. of compartments-------�------------Capacity_-Q11__ depth---o , --------------- 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_____________________--______._____-___________ 5_-._____.Distance to nearest lot line___-�s-__.__ Seepage Pit: Distance to nearest well/on-e, ________Distanc from�fou`ndation__ ,, e Number of pits__----`- -----------.Lining materia!- -[��-_s----Size: Diameter----------------------Depth------ ------------- - 91 Disposal Field: Distance from nearest well__AP063---Distance from foundation-11 _ ____-.DEstance to nearest lot line__-.�___---___ Number.of lines___._______/__-- ----- ---Length of each line---------- ------Width of trench____i4-`T___---------------- T e, of filter material__1_ Depth of filter material____, `�- --.- YP 1 i ----------------------------------------------------- Remodeling and/or repairing (describe):------�._C`��.2------t-n--ST-�'=-�-r-��_�_'Q �----------- -----------" -----=--------------------------------------- I hereby certify that I have prepared +his application and that the work will be one in accordance with San Joaquin County ordinances, State law and rules an regal 'ons of the San Joaquin Local Health District. Contractor) (Signed) x49� ontractor (Title r+.� (Plot plans, s ingsi a of lot, location of s stem in relation to wells, buildings, etc., must be filed with this application), - + FOR DEPARTMENT USE ONLY ��- - ------- DATE------ ---- �'- - "---- -- ----------------- APPLICATION ACCEPTED BY-----�-------------------- - --------- ---- --- ---------------------- - Y 11 ------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED -------------- DATE------------------------------------------------------------- ------------------- Alterations and/or recommendations______________________ __________-___-------- -------------------------------------------------------------------------- --------------------- --------------------------------------------------------------------------------------------------------- i ------------------------------------------- ----------- ------------------------_ ----------------------------- -------------------------------------------------------- ------------------------------ - F _ Date FINAL INSPECTION BY:----------VV------------------------------------------------ PERMIT --------------- ------ ' ----- ------------- PERMIT No/-/, --------- ISSUED � r 'S � � ) P IDate-- ----------- ------- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES_,j_2M 4-50 W-1639 _