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APPLICATION FOR SANITATION PERMIT - (Complete in Duplicate) ' a 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 LOCATION----------------6.24--5--{---Fr_ean0----------------------------------------------------------------------------------------- I i E% J _xQ= --- ----------- Phone-2-9-9-S-9---i------------ Owners Name r I - Q __ -t 'res-nQ-------------------------------------------------------------- ---------------------- - i Address-------------------- ---- ---- - -- ---------------------- Phone-----}=--39-5-5 II----------- Contractor's Name----------------D-� ��--------------------------------- -- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ®u� 'E _ Number of living units: ❑ Number of bedrooms ❑ Number of baths [I. Lot size__-_-_----0: 100------------- --- Water Supply: Public system EN Community system ❑ Private ❑ IClay ❑ Adobe'❑c Hard Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ pan El I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Distance from foundation-------------------.Material_ Septic Tank: Distance from nearest well------- _-.____:______------------------i:------- EXTr §TI`G No. of compartments---------- -------------- Capacity-----------------------Size--------------------------------Liquid depth-----------iL------------- ----Distance from foundation____--- Lining materia- ------------ ---�r: ------------ Cesspool: Distance from nearest well----------- ❑ ------- II Size: Diameter---------- -------- -�-------- Depth --------- ----------------- ---- -- - ,. 1. Distance from nearest building---- - ----- Privy: Distance from nearest well------------------------------- g !I nearest well - Distance ❑ Distance to nearest lot line--------- ---------------------------- 0 -- ' from foundation--------------------Distance to nearest lot line-_I____- Seepage Pit: Distance to Number of pits__--__1_-______- -- Lining material__rrjCqz-----Size: Diameter---------art- �'_Depth--------2V--- I--------- , j Disposal Field: Distance from nearest well------------------Distance from foundation--_-__------_--___.-Distance to nearest lot line- ---_---- rNumber of lines------------------------------------ .Length of each line------------------------------Width of trench-------------------�--------------- , EXE INI Type of filter material------------------------Depth of filter material--------------------- -- l t '! -Remodeling and/or repairing (describe):----------- d-ISLO3,3,j �--j4W:r-�F-er J Gi" -E:Y a�' � E3'J�>1`` lip l o Y's;1 F - ma k--w_j.t __so1iA---4 .--PiAeL----------------- -------------------------------------------- -------------------------------- p �j ----------------------------------- - - ---------- --------- --------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. ` . (Owner and/or contractor] (Signed).------------- -e -a---- ----------- - ---- - = -- - --------- ' �Y�----------��x'�'�--z��.�'��-'•i------��-'----� - ---- -- -----------------------------------------------(Title) Qi•=31.C<r��I�v'. ---- (Plot plans, showing size of lot, location of stem in relation to wells, buildings, etc., must be filed with this application]. FOR DEPARTMENT USE ONLY (- APPLICATION ACCEPTED BY- A DATE---- - I- It- - ----------- - i ----------- DATE------------------ ---------------------- ----------------- REVIEWED BY----------------- ----------------------- ---------II- BUILDING - BUILDING PERMIT ISSUED--------- -------------------------------------------------------------- DATE -- Alterations and/or recommendations----------------------------------------------------------- --------- -----_ --------------------- ----------------------------------------------- -------------------------------------------------- -------------------------------------------------- --------- ----- -- --------------------------------------------------------------------- - ------- -------- -- I PERMIT No.��---�--�------- ISSUED------- --- � --r Date FINAL INSPECTION BY: ---- ------------ -------- Date---------------------------------- ---- - --- - -- ---------------------- SAN -----------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California w ES-9-2M 9-50 W-1639