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A ICATION 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. l JOB ADDRESS AND LOCATION- - L "gG_S ON OF Ho d-_� f= = // S S `r<_ D -TUB ------------------------- ----------------------- --------- Phone_�f g Owners Name_�l_� ��-�------� -- - ,"° L. k'EN Dr b M A-w Z- ------------ - i !- Contractor's Name-------- ------- Phone----------------------------------- Installation will serve: - Residence T-1ApartmentHouse ❑ Commercial ❑ Trailer Court [D Motel�Other ❑ Number of living units: -F-1 Number of bedrooms F1 Number of baths El Lot size-------Z- --. ---T-- U-------- Water Supply: Public system L] Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel E], Sandy Loam [IClay Loam ❑ Clay [I Adobe Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu blic sewer is available within 200 feet.) �![ Septic Tank: Distance from,nearest well--- -,__Distpan itY... f �atisize___ 6 _ Maw t �Liquid depth___-_ �-.__;__.____No. of compartments____=____-_ __.--_______Ca aci esspool: Distance from nearest well-----------------Distance from foundation___________________Lining material________----____--_______----________. ElSize: Diameter---------------------------- -Depth--------------------- ----------------------------- ,Privy: Distance from nearest well----------------=---------------------- ----_Distance from nearest building---------- -------------_--- ----------- - a t ❑ Distance to nearest tot.line______________________________--------------- t, 1 Jf cepa Pit: Distance to nearest welL_____ .Distance from founda+ion____'_Z___-__.Distance to nearest lot lin e__.___________-. #. Number of pits______-------------Lining material. �_ ize: Diameter_____4�____-----.Dep+h---`.�_ _' ��----- �w F S Dis�osal Field: Distance from nearest well___1d0 ._.Distance from foundation____ _________Distance to nearest lot Ime_________________ -Len th.of each line___-____ __._.Width of trench^ ._ "U d Number of lines_________________ _____________ - -- Type of filter`material__:._ -Depth 6f filter material________- r____-___ Remodeling and/or repairing (describe)----------------------------------------------------- ---------- ------------------------------------------------ ------- --- -- --- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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. (Signed)_ Owner and/or Contraeto- -.a c By:------------_. -------------------------_---------------------,----------.-------------------------------------- .Idin s mus#Tbeefiled with this application], �� (Plot plans, showing size of lot, location of system in relation to wells, but g , etc. t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -- -------- --- S__ ------------------------------------------------------------------------ DATE---- - REVIEWED BY--- ---------------------- -- - ------- DATE__?r__2--r'/_�r----�70------------------------------- ----------------------------------------------------------------------------- - BUILDINGPERMIT ISSUED-------------------- - --------------------------------------- DATE-------------------------------------------------------------� Alterations and/or recommendations---------------------- ----------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ------- ISSUED--- fu`�'_------------(Date) FINAL INSPECTION BY:--------------- ---�` '--------------------------- - Date--------- , PERMIT No.__.�--------------- _1 p~ y ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California " E —9-2M 9.50 W-1639 yam;