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4 APPLICATION FOR SANITATION PERMIT I [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. -k } JOB ADDRESS AND LOCATION---- 147------- ----- ------------15----------Dra In ne----------------------------------- aY=LS --------------------------------------------------------------------- Owner s Name________________ - - Address------------------- -- ------------ ------------------------------------------------ -------- - -------- ------------------ Phone---------------------------------- -A - Contractor's Name-------------------------------- p --- ' -=---------------------------------------- - - Installation will serve: Residence 4J Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: . Number of bedrooms g Number of baths 0 Lot size-----------_5 ------------- Water Supply: Public system ❑ Community system ❑ Private AdobHardpan ❑ Character of soil to a depth of 3 feet: Sand F] Gravel El Sandy Loam [IClay Loam [I Clay ❑ e TYPE OF INSTALLATION AND SPECIFICATIONS: wer is available within 200 feet. (No septic tank or cesspool permitted if public s AA Se tic Tank: Distance from nearest well--- ---Distance'fr�,n foundati _-__--- -- V- ,:_.Material ---------- )n - -------------� " p d --- _SiX'a_�(_ - ,Liquid depth------ ------------ ` --Ca aci# to No. of compartments_______________________ -- -Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_--_-__-----____-----_-___ 1 ❑ Size: Diameter--------------------------------------Depth--------------------- ------------------------- - • -------------------Distance from nearest building -------------------- Privy: Distance from nearest well------------------------- --- ---- - ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-______---_---.__-.Distance to nearest lot line----------------- ❑ Number of pits Linin material --------------- Size: Diameter Depth ------- Dis osal Field: Distance from nearest well---_- -_-__--_Distance from foundat ___-Distance to nearest lo0lir�B________________ 1. Width of trench Number of lines-------------- Length of each line--- t1 O�rDepth of filter material____-_-� --------- Type of filter material-_-.�_�__-�- r(; -----------------------------------•----------•------------------------------------------------------------------- Remodeling and/or repairing (describe}____________________ - ---_ -- •-- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------- - hereby certiti fy that i have prepared this application and that the work will be done•in accordance with San Joaquin County ordinances, State aws, and rule'and regulations of the San Joaquin Local Health District. Owner,and/or Contractor] (Signed]. r ==` ----t------- . •r==&OW OF --- --------------------------------- By:---------------------------------•----- ----------------------------------- - --- ------------------------------ Title -------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application . - DEPARTMENT USE ONLY APPLICATION ACCEPTED B ______________ _ ___ -- - - ---------------------------------- DATE---------- --- --- --- ------- -- ------------------------- ---------------------------------- ---------- DATE---------------------- -------------- --------------------- t ----------------------------------------- DATE-------------------------------------------------------------- ---------------------------------------PERMIT ISSUED -----------•------------------------- ----------------------------------- Alterations and/or recommendations---------------------- -----•-------------------•------- -----___-------_--- ---------- ----------------------------------- ------- -------------------- ---------------------- ------{Date] FINAL INSPECTION B) : - --- ------ ------ PERMIT No.,---7--Y�--- ISSUED------- D � I i ---------------- Date---------------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-9-2M 9-50 W=1639 '}