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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thework herein described. This application is made in compliance with Coua y Ordinance No. 549. i� JOB ADDRESS AND LOCATION- __^�__ / ------- - ---------- Owner's Name.----/-,- _ de ------ --- ��-Ole -c--------- Phone ---- - ------------------------------------ one--------------------- Address - ---Address-------------=----- ---------- e - - ----------- / t ! ------------- Contractor's Name----------------------------- --------------------------.Phone_------------- ----------------------------------------------- Installation will serve: Residence Apartment House E] Commercial El Trailer Court p Motel El Other El Number of living units: J Number of bedrooms ❑ Number of baths ❑ Lot size-----------47-41_1q 4 Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [yf Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sepfic Tank: Distance from nearest well-----------------Distance from foundation-.-----.------------Material --__-___-_-_______-- ❑ No. of compartments--------------------------Capacity------------------ Size -- ---------- -----------------------_------ L;quid depth � -I ----------- . - Cesspo Distance from nearest well_- ,_Afrom foundation_____1dLinin maferial_-_/ -___---� 10, Size: Diameter-----"'�---�-�'--x- - ---------Depth-------------�--Q--// � -Privy: Distance from nearest well-----------------------------------------------_Distance from nearest buildin g ---------------------------------- ❑ Distance to nearest lot line------------------------------------------------ I Seepage Pit: Distance to nearest well----------------------Distance from foundation---__----.---_-_--.Distance to nearest lot line--- _-___-----_ �`•J ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth-------------------°------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--_il_ ElNumberof lines---- -----------------------------Length of each line-----------------------------.Width of trench ------------ ��------------ Type of filter material-------------------------Depth of filter material----------------------- Remodeling and/or repairing (describe):__---_---------------------------------------------------------------------------- II ------------------------------------------------------- - --•---------------------------------------- ----------------•----------------------------------------------------------------------- -------------------------------------•- --------------------------------------------------•------------- I - 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 rules and regulations of the San Joaquin Local Health District. (Signed) ---------------(Owner and/or Co ltractor) ------ --------•---------------------------------- BY� ' _ {Title) II (Plat plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). s "• FOR DEPARTMENT USE ONLY �I a I� AlkLICATION ACCEPTED BY_______________________ --------- _W- DATE - =' ---------------------- ------------------------------- y R REVIEWED BY ------------------------- ................................. DATE------ --------�----------- BU I LDI NG PERMIT ISSUED--------------------------------------------------------------- ------------- DATE------. . ---------- --------- Alterations and/or recommendations:_-------___ I----------- - ---- ------- - - -------- _ :�- ------ --- ---- -- { — ----------------------- ------ -- ------- --------------------- ----- I --- --------------------------- ---------------------------------- --------------------------------------------------------------- (Date) -- PERMIT No.si_#------ ISSUED---- --_?�- s�/---- FINAL INSPECTION BY---------------- -- . �. - Date if _+ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street SI ES-4-2M 9-50 W-1639 Stockton, California i I '