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as 4�� �i APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is herebyrm' acie to the San Joaquin Local Health District for a permit to constr �nd install the w l�efein ibed. This application is made in compliance with.County Ordinance No. 549. }' JOB ADDRESS AND L ION-----''-- ` -------------------- Owner's Name_____________�--- r Phone W�_- ----- ....15-7 Address------------------- f IfV. fPhone--- f�-'- � Contractor's Name ? -J-- ----r''-''= : Installation will serve: Residence Apartment House El Commercial El Trailer Court ❑ Motel E] Other ❑ Number of living units: Number of bedrooms A Number of baths Vj Lot size_-___ Water Supply: Public systemCommunity system ElPrivate ❑ r� F Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑- Clay.❑ Adobe Hardpan ❑ 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 foun tion sp________.Material_____ 1� . �-r: ,�: --�_�:----Liquid depth-�J--------------------Z111. No. of compartments----0A1 -------Capacity__/v ..'_' Size____ 0P � �e spo Distance from Fnearest well-----------------Distance from #oundation______-_ ----------Lining material__________-_____-____._-�__________. r ❑ Size: Diameter--------------------------------------Depth--------------------- ---------------------------- iPrivy: Distance from nearest well________-_ ------------------------:-;�------- ----------Distance from nearest building----_,--'-------- ----- -----� ❑ Distance to nearest lot line------------------------------------------------ Seepage -- -----Seepage Pit: Distance to nearest well____._________-___Distance from foundation____________________Distance'to nearest lot line----------------- -------- Size: Diameter-----------------------.De th------------------------ ------- i ❑ Number of pits______________________Lining material---.----------__ ---- p f , Disp sa _ ield: Distance from nearest well-_& - -__Distance from foundation_- --------Distance to nearest lot line- ------- - j'�" Lerr th�of each line_ - s Width-ofrtrench___ -- ----------------- Number -- ----- Number of Imes `___:_- 3i-- _ �-` � if � -- g Type of filter material_ __llte_ -Depth of filter material________-:___ , Remodeling and/or repairing (describe):______ ^ =-- ---•' - - -------------------------- -------------------- -------- - - ------- ------ ,�, }//��fT _ ------ - ------ - ------------------------ -- � --______________________ _ ----------- hereby certify that I have prepared thisplication and that the work will be done in accordance with San Joaquin Coun ordinances, SWe laws, and rules a gulati s of the San ty Joaquin Local Health District. l � Y h r �l .......... 1 �i---------------(Owner end Contra 'tor) r5o - --- `` {``----- - --- __C__ -- _1'11`` - �• (Title} BY� (Plot plans; showing size of ot, location of system in relation t wells, buildings, etc., must be filed th this application}. j DEPARTMENT U�10JNLL�Y. DATE-------- APPLICATION ACCEPTED BY--------------- - -- - ---------------------------- ------- r REVIEWED BY----------=------------------- - DATE--- ------------------------------------------------------- ----------------------------------------------------------------------------------------------- BUILDING PERMIT,.ISSUED--------------------------------------------------------------------------------- - DATE ------------------- 6 Alterations and/or recommendations_____________________________________________ ----------------------------------- ------------------------ i ___________________________________________________________ PERMIT No._�_�__ -------- ISSUED-�- � t - - - ---- ---------------(Date)-FINAL INSPECTION BY:------------ ------------------------ - - Date----------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-9-2M 9-50 W=1639