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APPLICATION FOR SANITATION PERMIT ZIA/ (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. I / JOBADDRESS AND LOTION------------- �--,�----�----`-f__ ------- �..----__�-n-�--------- -----�-----•----------------------- •-------------------- ------ Owner's Name -*A,r• _-4. ----�- a --------------- Phone------------------------------------ Address-------------------------------------------------=------ ---------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name------------------- R D U ----------------------------------- Phone----------------------------------- Installation will serve: Residence ['� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: umber of bedrooms 3 Number of baths V Lot size___- -------------------- Water Supply: Public system [ Community system ❑, Private ❑ Y (c,�� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 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 ank: Distance from nearest well---—------.Distance from foundation_._.__�9__-____-Material_______ __ ��______________ N No. of compartments_______—_ ______Capacity------ 44_ � r - k--* -Liquid depth_______________________ - ---Size--- --� - --- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-------------------------------------- El _-___________-_ _________________-_.❑ 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--------------------------------- Dis os ield: Distance from nearest well_________________Distance from foundation___/ _---------Distance to nearest lot line-____ ___ _ 1 p� Number of lines________:_:�,;'r----------Length of each line_/6'__ �__'_ 4_.Width of trench----- M s Type of filter materialJ ------Depth of filter rhaterial_____ -"________ Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------•----------------------------------------------------------•--------------------------- k hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County E ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, (Signed)----------- -------------------L ,/ ----------------------------------(Owner and/or Contractor) /V v BY��- -- --��---------------------------------------------- -----------------------------------------------------(Title)•---------•----------------------------------------------------- (Plot plans s wing size of lot, location of system in r ion to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE 2 r REVIEWEDBY-------------------------------- ----------------------- --------------------------------------------------------------- DATE_---------------------------------------------- --------- BUILDINGPERMIT'ISSUED------------------------------------------------------------------------------------------------------ DATE----------•---------------------------------------------- Alterationsand/or recommendations=------------------------------------------ --------------------------------------------------•-------------------------------------------------------•-------- --------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- - ------•-- ----------------------- -- ----------3---- - ---------------_`��----------------------------- --------------..--------------•------ -- -_ --------------------------- PERMIT No.I -------- ISSUED = 3______ Date FINAL INSPECTION BY:_ e._' '" Date------------ } == ----------------------•----------•---•---- f - d SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639