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2�{ APPLICATION FOR SANITATION PERMIT (Complefe,in Duplicate) CTO .1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and i sfall A ork herein descr'bed. This application is made in compliance with County Ordinance No. 549..bUL ! ' 9 �+ JOB ADDRESS AND L CATION______1T__ -'�____ __�_�__`__�__�,-_ + � r ----------------- --- Owner's Name----/1f ------------------- ^ - ------------- -------------- -------- ----- Phone------------------------------------ Address-- ff ---- - ----------------------- =f ----------------- � .. Contractor's Name ' -- 5r- Pho +----------- Installation will serve: Residence ElApartment House ElCommerciale Trailer Court Mo, te Cher ❑ Number of living units: 71 Number of bedrooms ❑ Number of baths ❑ Lot'size------_-_---_-------------------------------------_--__--- z Wafer Supply: Publics stem ❑ CommunitY system ❑ Private Com` Character of soil to a-depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) Q ` �49 + Septic Tank: Distance from nearest well 3.4,-- --DisfanAp f o ��nd�art on_---_-_-__-------.Material------------------------------------------------ — . Liquid depth----__--__---------_-_--_ Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material----______-------_--_---___-:--- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distancekfrom nearest building------------------------------------------ ❑ Distance to nearest lot line----------------- ----------- - Seepage Pit: Distance to nearest well----------------------Distance from foundation---_ ----------------Distance to nearest lot line_-------__--_____ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth-------------------------------- ..Disposal Field: Distance from nearest well' '� -------Disiarice frarri foundation--__=_—AF- -_ Distance to nearest.lot line___.____.___.__ . Len th of each line-----_- -----__-----.Width f french_-.-'� ----------------------- Type --------_- [ Number of lines________________ g _--- 1 Type of filter ma#erial-_-� _ Depth of filter material----------- -Remodeling Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------------------------------- ------------------------------------ f a --------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ - I hereby certify that I have prepared this application and Aaf the work will be done in accordance with Son Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- _ '-=-1----- +_kA ----- �-----------------------------------------------------------------------------------------------� and/or Contractor) 13 (Title)_ Y•--------- ------------------------------------------------------------------------------------------------------------------------- (Title)-- aAAJ-r� plans, showing size of lot, location of system in-relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ s :DATE _ - -------------------- F.. .., --- ---------- I ;4 - REVIEWEDBY-----------------------------------------------------------------------------------------I----------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------_------•--------------------------------------- DATE--------- ------------------------------------------ Alterations.and/or recommendations:------------------- ------------------- ----- - --- ---- ---------------- --------------- ----- ----- U-y------------------------- ---------------------------------------------- - - ------ --------------------------------------------------------- --- - _ - o �---------- � _ ------------------ -- - �f ------------------------------------------------------------------------- - ------------------------ - : .�: _-------__-._ _. __._.- ---------__----_- PERMIT No------------ " ISSUED----- ---------------(Date) FINAL INSPECTION BY:----------------------------- --------------------------------- Date--------------------- --------------------------- -- - ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES---9--2M 9-50 W-1639.