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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) I, � y Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein!de�-scribed. r This application is made in compliance with County Ordinance No. 549. a ' Gl, 4�e JOB ADDRESS AND LOCATI N-- Y51� --------fi-Y6-4------ I-r�tey ------ Owner's Name- Address ---- ---{-------- ----------------------------------------------------------- Phone_ P We -----�_ e'r Contractor's Name - Z&,, Phone_7- -V ------- Installation '— ------ Installation will serve: Residence [ Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ) Number of bedrooms Number of baths Z Lot size- Q� X-� Q ------------------ Wafer Supply: Public system ❑ Community system ❑ Private ❑ 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.) r � Septic Tank: Distance from nearest well.-__-- --------Distance from foundation--/---- s ... liquid depth:6,r`-�.' i Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___-----__---_----_--__-_-----_-___-. ❑ 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----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth------------_-------------------- Disposal Field: Distance from near�well_____�='__.Distance from foundation-_�f,-__-_-_--Distance to nearer,Jot line--�-r_. Number of lines____v-_1�_� _�._ __-_---_-Length of each line__7( f---- - -__�1-_"Width of french- .,A-4 _ Type of filter material/� -_�!!,- Depth of filter material---_-� ------ Remodeling and/or repairing (-------------------------------------------- describe):---- - -------- ----------- -- ________ - �---------- -- ---- 1 -- ----- r--------- A _W -1 M. -----------------------------•-----------------------------------•--------•------ --------------- ----------------I----__-4-------------_-- ---------- ------------------------------------------------------------------------------------------------------- ----------------------------------------------------•-------------•--------------------- I hereby certify that I have prepared this application and that the work ill be done in accordance with San Joaquin -County ordinances, State aws, and ru2anclla+ions of the an Joaquin Local ealth District. a' (Signed]_•-_ - OwnerZanr Co tractorPlot Bns, showin siz oca+ion of s rte relation t well (Title)____________ ____________ _ ________________ t ( P 9 y s, buildings, etc., must be filed ith this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE f �--------------- t REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------•------------------- ------------------------------------------------------------------------------------------------=-------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••---------------------------------------- --------------------------------------------- --------------------------------- --------------------------- --•-- - --- -------------------------------------------------------•--------•------------- ------ , PERMIT No------7_L---4------- ISSUED-----9'-4---5__l------------(Date) FINAL INSPECTION BY--------------- /Ze ---- Date---------------- ------- �------------------------------ SAN - =SAN JOAQUIN LOCAL HEALTH DISTRICT- 130 South American Street Stockton, California ES-9-21v1 9-50 W-1639