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r 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 incompliance with County Ordinance No. 549. �/ JOB AD[ S At/D LOCATION---- D O -------63, ----- ?—--��--- +'_ Owner's Name--- ------- �'=f�---------------------------- -------------------- Phone---- ------------------------------- Address---2/-d----- -------{---------- � �y_ Contractors Name__i�i-AA----- �t�1�r _ -__ -------------------------�aefle [ �/ :_l__'� r__L/_40__!--_-- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: '❑ Number of bedrooms ❑ Number of baths LL_ Lot size____`__ .G..___—_________________________ Wafer Supply: Public system 14 Community system [❑ Private ❑ Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe JA Hardpan ❑ 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---__—---Distance from foundation-----.1-30.......Material----- �!.�5-• -------------- No, of com artments__-__ -------------Capacity----,�� _____Size___ depth____� � Cesspool: Distance from nearest well-----------------Distance from foundation------------_------.Lining material____________________________________- ~ ❑ Size: Diame#er--------------------------------------Depth---------------------------------------------------- ` 'Priv Distance from nearest well----------------------------- ___Distance from nearest building ❑ Distance to nearest lot line------------------------------------------------ ., N. Seepage Pit: Distance to nearest well �- -~-_�'__Distance from fo ndation_____ _____.Distanc to nearest lot line_________ Number of pits__________-_-------Lining material___��__ Size: Diameter----- dl ________________ } 4_Disposal Field: Distance from nearest we11_______`_-_____Dis+ante from foundation-------2a_-t---Distance to nearest lot line__—�._ ______ Number of lines__________ ___ ___„__ _ Length of each line______?_ -------Width of french----_-21V_ -------------- Type of filter ,ma+erial_f�- ---___Depth of filter material '-'-______ Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------- -----------------------•------------------------ ----------------------•---- -------- ----- - ------------- - --- -- ---------------- --------------------------------------------------------------------------- I----------------------------------------------------------------------------- -----------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 a 9 ) -- -- ----- -------- -------------- - "" --------------------------------------------------------------(O mwo-e►cf/or Contractor) BY: {Title "�""' ------------------------ (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with Phis application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- - -------------------------------------- DATE-------------- --------------- REVEEWEDBY ----- ------------- ---------------------------- ------------- DATE- ---------- — ------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations---------------------------------------- ------ ---------------------------------------------------------•---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------1-------------------------------------f--------------------------------------------------------------------------------------------------------------------------------------------------------------- PERMIT No------L-51--------- ISSUED----b - -------------------(Date) FINAL INSPECTION BY:----------( �� ------------- -------------------- Date----------------- �' -� --------- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639