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F (� r APPLICATION FOR SANITATION PERMIT ! .f (Complete in Duplicate) f 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. J �T JOB ADDRESS AND L,O/CATION �{ ---------------- ----------- Q_hea -----------�-----� a��-/__�"'"Q`-�pA r� Owner's Name---------- f?/� A �? _/ r' Phone--- Address------------------------1-=/--�G------ -=�----W011� ---------------- ---------------------------------------------------------------------------------------- iContractor's Name------------------------- 1----------------------------------------------------------------- --------------------------------------------- Phone--------------------------- i Installation will serve: Residence [A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms [J— Number of baths V1 Lot size_____ ________________________ Water Supply: Public system ❑ Community tystem ❑ Private Of Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe A Hardpan ❑ k TYPE OF INSTALLATION AND SPECIFICATIONS: (No_septic tank or cesspool permitted if public sewer is available within 200 feet.) ,.0 t / Septic Tank: Distance from nearest well---1_5-------Distance from foundation___ _________--Materiial___A-------------------------------------------- [� No. of compartments---------7'------------Capacity 9-101-------Size--------------------------------Liquid depth---/o/--__--------- .• Cesspool: Distance from nearest well-________________Distance from foundation--------------------Lining material-_______-__---------_________________. ❑ Size: Diameter-I----------------------------------Depth---------------------------------------------------- I Privy: Distance from nearest well------------------------------------------------- from nearest building-------------------------------- El 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-_ ;______.Distance from foundation___1� ______Distance to nearest lot line____5_-....._ Number of lines'°_______________'L___________Length of each line_______ .d______s�_____-Width of trench-------+r� ��____________ Type of filter material___RPC_k--------Depth of filter material-------/X__________ 1• Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------- t I r 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) T ------ - --------- --(Owner and/or Contractor) - (Plot plans, showing size of io+, location of em in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- +° ----- ---------------------- DATE REVIEWED BY - DATE BUILDING PERMIT ISSUED----------- --;------ DATE--------- --- f Alterations and/or recommendations------------------------------------------------------ --------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------•-----------------------------•---------------------------------------------------- .............------•-.------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PERMIT No.---"--,-------- ISSUED�_ 1��s--�---------{Date) FINAL INSPECTION BY:-------// _.__- -------------- Date_ j - s, SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street Stockton, California ES-9-21A 9-50 W=1639 F