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APPLICATION s-11. CATION 1=0R SANITATION PERMIT h (Complete in Duplicate) . i I 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, JOB ADDRESS AND L CATION c�__/_�0 Owner's Name � � ------------ ----------------------------- ' ----------- Phone Address------ U � ;�-( -- - - -- --------- --------------------------------- Contractor's Name •:------ '' "r !_ hone---J�� P "t --- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑+ ! Number of living units: Number of bedrooms 17 Number of baths � Lot size_____ ---/-'5 Water Supply: Public system Community system Q Private ❑ Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hard an is P ❑ ❑ Y ❑ Y ❑ Y ❑ � � ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S ptic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_-_-___________-_---__________________-___-____. No_ of compartments Capacity. - Size----------------------- --•Liquid depth---------------------------- Distance ------------------ --•-- Distance from nearest well-----------------Distance from foundation--------------------Lining material________- ____________--________. ❑ Size. Diameter------ ------------------------------Depth-------------------------------------------------- k 2 Privy: Distance from nearest well------------------------------------------------- from nearest building_____________--__------_________,________- ❑ Distance to nearest lot line------------------------------------------------ /� �--- .�+t�___ _ % istance to nearest lot line-_ ` Seepage Pit: Distance to nearest w/ell---oy- ______ __ Distanc from foundation__- r ' Number of pits-------1_------------Lining material_ ___ A $iae: Diamet ----------Depth------_t ____ ---- Disposal Field: Distance from nearest well_"-----.:_--_-'Distance from,foundation-____—------------Distance to nearest lot line_________________ I ❑ Number of lines-----------------------------------Length of each line-----------------------------:Width of frericli-- -------------------„__------ Type of filter material_________________________Depth of filter material__-_______________:__ t 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 rul -a d regulation{o fthaAan Joaquin,local Health District. # (Signed)------- '... ------------ ------------------------------------------------------------------------------------(Owner and/or ontractorM gY:------------- --------- --------- -- - -----:-----------------------------------------------------------Title--------- - `=-s4--------------------------------- ------ (Plot plans, showing size of lot, locati of system in relation to wells, buildings, etc., must be filed with this application]. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE--------------------------- REVIEWEDBY---------------------------------------------------------------------------------------=----------------------------------- DATE BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------- Alterations and/or recommendations__________________________ ____ -d _-----__- vti,, ---------------------------------------- �- -� U- - - 1 - - ------------------------------------•------------------------------------------- ---------------------------------------------------------------•------------------------ -----------------------------•-•-•1-----------------------------------•---------------------------------------------------' ------------------------------•----------------------• -------------------------------------------------------------------------------------------- --------------------------------- --------------- PERMIT No----- --1------- ISSUED----- ---5 --------(Date) FINAL INSPECTION BY:------. -- --% "-------------------------------- Date-----------------------9-, la-----177I- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639