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r �F 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 Ord;ante No. 549. DSS—_3 -320 '�(pp'Z (-fL 6FEr<I�4( 4 cj �� `�� __- -w"t.-------------- - - -------- --- JOB ADDRESS AND LOCATION_------- ------ Phone----------------------------------- Owner's Name- ----------- ---------------------------------------------------------------------------- --------------- _-___---- -__-_ Address----Ifo-_ ! J I one-- ------------------------------ Contractor's Name-.-_ _A%__----- Other ❑ ` Installation will serve: Residence [3 Apartment House ❑ Commercials Trailer Court ❑ Motel ❑ -�- Lot size--- -�1--vimt %_'r d � ------- , Number of living units:" Number of bedrooms F-1Numberof baths ❑ - --------------------------- Water Supply: Public system F1 Community system El Private I Character of soil to a depth of 3 feet: Sand r-1Gravel ❑ Sandy Loam ElClay Loam [I Clay E] Adobe Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) arest well_________________Disfiance from foundation___-________---_- __.Material----------------------------------------------- Septic Tank: Distance from neLiquid depth----___--____._--_-______ ❑ P ••-------------------Size--------------------- q No. of compartments__________________________Ca Capacity Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_-----_-----_.-_-_------------ ❑ Size: Diameter--------------------------------------Depth--------------------- ------------------------- Privy: Distance from nearest well__---.___-_________ --------------------------Distance from nearest building--_--------------- -- El Distance to nearest lot line ------------------------ er/' t DD- ____Dis#ante from oundation-_-- __----.Distanceto nearest lot line_____.---- Seepa e Pit: Distance to nearest well---- , Number of pits-------/------------Lining material__________ Distance to nearest lot line-=.___:----_ , Depthnzsr^I'�± -. ¢ b„r ______Size: Diameter------ _-- -- Disposal Field: Distance from nearest well---__-__-_-----.Distance from foundation-----__•______---__- ❑ Number of lines-----------------------------------Length of each line-_------___------------------.Width of french--------------------- Type of filter material--------- -----------Depth of filter material----------------------- --------------•-------------------------'------- Remodeling and/or repairing (describe):----------------------------------------------------- ---------------------------------------- ---------------------------------------------------------------------------------- ------------------------ ----------------------------------------------------------------------------------------------------------------- I hereby certify that I have les prepnd ared this application lli the San Joaquin Local Heallth Distrix}n accordance with San Joaquin County ordinances State �/or Contractor) (Signed] l----. --- - --.-"-F"-�-�ti."_"_"-.'"�.-------------------------------------------------- ---------- ----- (, ] -[Title] ---------------- ------- BY (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application]. FOR DEPARTMENT USE ONLY DATE------- -- --------- - APPLICATION ACCEPTED BY------ ------ ------- REVIEWED BY------------------------------------------- - -- _ ------- BUILDING PERMIT ISSUED-------------------------------- --------------------------------------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations:-------------------------------------------------------------------------- ------------------------------------ --------------------- -------------------------------------------------------------------- - / / bA 7'7 Date FINAL INSPECTION BY------ - ----- --- ----- -------------- PERMIT No.--�)-� ISSUED ---------- --------- ( ) Date---- --------- -------------------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5--9-2M 9-50 W=1639