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APPLICATION FOR SANITATION PERMIT � 55 (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work This application is made in compliance with County Ordinance No. 549. rk herein described. JOB ADDRESS AND LOCATION ---•----�--____ ��--/ Owner's Name =--------------- ---��..F N ,�f/� F --------- Address--------- ' '----------------------------------- Phone I------------- --------------------•--- —� �'0 . . r.�.. I/, ,r Contractor's Name------------ -------- - -- ----•-------___-- ' Installation will serve: Residence ----------------------------- - Phone------ 1: Apartment House ❑ Commercial Number of living units: ❑ Trailer Court ❑ Motel ❑ Other ❑ [�Number of bedrooms d Number of baths Water Supply: Public system ❑ Lot sixe__ _"��-� ---.q o Community system E] Private ❑ \ , Character of soil to a depth of 3 feet- Sand I V ❑ 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 Tank. Distance from nearest well________________Distance from foundation _ _ ❑ No. of compartments_________________________Ca acit ----------------------- - _____ ---Material Capacity _ - ---- ---------Size_ -� �.- - ---------------------------� Cess !: . --=--Liquid dept _ Distance from. nearest ell_______ Distance from foundafion-___�9---------Lining material------ Privy: Size: Diameter_3-_-?�_-- ---x-_ Privy: _ Distance from nearest well--------------- Depth - ------ ®/ Distance from nearest buildin --------- Distance to nearest lot line----------- _ Seepage Pit: Distance to nearest well � ` __-_Distance from foundation-------------------- ❑ Number of pits_______________ __Lining material____-_ Distance to nearest lot line___------_ Dis osal Field: Size: Diameter------------- Depth----------------......�� - P Distance from nearest well_________________Distance from foundation__-___.________-___.Distance to nearest lot line________I--- ri Number of lines-----------------------------------Length of each fine --------------- of fiiter material----------------- ---------- •Width of trench--------------- ___-__Depth of filter material--_------------------ Remodeling ,_____-__--____Remodeling and/or repairing (describe):__--__ - ----------------------------------------------------------------- r C[J < T .�--- - - ;; - -� �. ------------------------------------------------------------ ----------------------�_ � I.. -s Pm_a_ 1 i� � ----------- - -- - --- - -------- Ihereby,certlawsh and have ae r d t_ r_iP_ C'.r ----f�-r✓�--- -- ------ ------------- ---- ordinances, �� rule Y. prepared this a lica+ion and that the work will be done in accordance with San Joaquin County + and' regulations of the San Joaquin Local Health District. (Signed}_✓_ I Y:------------------------------------------------------ ----- (Owner end/or Con+ra, i tort (Plot plans, showing size of lot, location of system in relafion to wells, buildings, etc., must be filed with this application ------------------------------------(Title)-------------------------------------------- - - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________________ /� REVIEWED BY-------------------------------------------- DATE �„.� l BUILDING PERMIT ISSUED_ DATE ---------- ----!_ ----------------------------------------- .......... ----- ---- Alterations and/or recommendations--------------- DATE__.----------- __ I f ----------------------------------•------------------ --------------------------------------------II ---------------- --------------------------------------------------------------------------------------------------------------- �- II ------------------------------------- _ - r ------------------------------- ----------------------------------------------------I / ` __ d - PERMIT No._ 0rZ„I_-_ ISSUED___`�� _-•�/ '-�--' ------.___(Date} FINAL I SPECTION BY_____ _ --------•---------- Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street E5-9-2M 9-50 W=1639 Stockton, California,