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APPLICATION FOR SANITATION PERMIT (y { (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. r JOB ADDRESS AND LOCATION---- `5,3 60 --------12 /C---T_ � r�C/L.I Owner's Name-------------A,_ f-'; --------------------- ------ Phone----------.._� -- ------------------------------------ - --------------------- Address----- --------------------------- }� � Contractor's Name-------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence 0, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p Number of living units: ❑ Number of bedrooms 2- Number of baths V Lot size-------_-L4_ - --�-Z V--------------_--__._ Water Supply: Public system ❑ Community system ❑ Private i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay A�Adobef< Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q Septic Tank: Distance from nearest well-- •__--_Distance from �. foundation-__-_-lQ-2-Material____________ No. of compartments ----- -CapacitY--- � ----Size-----� Liquid _dept_h_------:47"o__-----c-�- _---_-_-. 1 � Cesspool: Distance from nearest well--------------___Distance from foundation-------------------.Lining material____----__-__-__-------__----_-_-___s ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well---------- -----------------------------------Distance from nearest building--_---_-_-----------______-----___----__. ❑ 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--------------------------------- DisosField: Distance from nearest well-_-45 y--.Distance from foundation_----?2"___-Distance to nearest lot line--_ Number of lines------------2.-----------------Length of each line------- ---------Width of french _---_----2'�//-.-__--_-----_ Type-of filter maferial_-Ax_*_*-'-*----Depth of filter material------- ------ Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------• --------------------------------------•- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I 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 o the San Joaquin Local Health District. (Signed) "v ' = -------------------------------------------------------------------- _______(Owner and/or Contractor) By:-----------------------------------------------------------------------------------------------"----------------------------------(Title)--------------------------------------------------------; ~ (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 APPLICATION ACCEPTED BY------ ------------------------------------------------------------- DATE---------- - ", , REVIEWED BY------------------------------------ -- . ------ ---------------------------- DATE------------------------------------ BUILDING PERMIT ISSUED-------------------------- DATE ; Alterations and/or recommendations-------------�� --------------'---=f-------------- `----t------------ '. !�=== ---------------- ----------------------------------------------------------------------------------------------------------------------------------------_----------------------------------------------------------------------------------- ---------------------------------------------------------------------- -------------- ---------------------------------------------------------------------------------------------------------------------------------------- ------------------------------•-------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ --------------------------------------------- --------------•--- ------------------------------------------------------------------------------------------------•---------1-------------------- PERMIT No.__-LP.- ---7---- ISSUED------3r ---------(Date) FINAL INSPECTION BY:--------t G -!!- ---------------------------- ` Date / ----- � -------�------'-�-----'�f ------------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639