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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 the work herein described. This application is made in compliance with County Ordinance No. 549. xcfo Z:.. �'t:c.c_-ra,j s7- :• //s- /(os— o f JOB ADDRESS AND LOCATION__ r .� � ,�✓_ - Owner's Name----- -4�'-`-f=--- -- - --• Address_ Phone ------ __l__ Contractor's Name______ 1 ---------------------------------------------------------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial Phone----------------------------------- ❑ Trailer Court E] Motel F] other Number of living units: ❑ umber of bedrooms Number of baths 21 Lot size _�`_- '_ � Wafer Supply: Public systemCommunity system ❑ Private E] ------ - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobe❑ Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f `) Septic Tank: Distance from nearest well------ from foundation____,-S� Material____.___.__-C/�2fii/ � f" a . No. of compartments_---------7" Capacity-_--__ fS'(� �' X__. Size -- �� -Z ___ cesspool: - -----Liquid depth---------5_---- A. O �' ❑P Distance from nearest well_________________Distance from foundation__________________ Sizer Diameter-------------------- Lining material--------------------- � ----------------Depth--------- ---------------------------•------- -- Privy; Distance from nearest well__________________ _______ Distance from nearest building----------------- ---------I'. ❑ Distance to nearest lot fine----- - Seepage Pit; .Distance to nearest well•____________________Distance from fou_ndation___________________Distance to nearest lot line ❑ Number of pits-----------------------Lining material------------------------ r -------------Size: Diamet�r-----------------------.Depth--- � . Disposal Field: Distance from nearest well--------_____.Distance from foundation________ _ -S --____Distance to nearest lot line=_ Number of lines------------------ ------------Length of each line---------_0_-__--__ Width of french---- Type of filter material___ 1`v +___ Depth of filter material_____ V--- j ----- Remodeling and/or repairing (describe):_______________________ ----. y€ mo 2�f I C!✓.- - ---'----------------- ------------ w -•------------------------------------------------------ . ! hereby certify that f have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, Stafe laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ lrr: .......��... ------------ ----------------------------------------------- (Owner and/or Contractor] By------------------------------------------------------ - ---- - ----- --- -- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., mustTbeefiled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- REVIEWED BYDATE a--------------------------�---------- - '� --`r�----- - - DATE a� BUILDING PERMIT iSSfJED---------------------------------------- _- . Alterations and/or recommendations------------------- DATE---•--------------- -------------------------- ---------------------------------------------------------•--------- -- . -r----------- � - ---• ` ` . ..�-- _ o `� � lam -- --------- -- ""----`-------`�=-- ---------- ` _ _ _ --------------------------------- ------------- PERMIT No------ ___ _ ______- ISSUED___ _—h '-- -- -- ------- (Date) FINAL INSPECTION BY:____ Date ------------------------ �. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES--9-2M 9-50 W4639 Stockton, California