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APPLICATION FOR SANITATION PERMIT ,,... (Complete in Duplicate) Application is hereby eb made to the San Joaquin Local Health District for a permit to construct and install the work herein described. . Y This application is made in compliance with County Ordinance No. 549. f �� ADDRESS A a -OCATION.___'__..____ __-_> ---------::aw_ _f N------L ------------ JOB ---- Owner's Name----XZ--c -a-------- Q'--------- ------------------------------------ Phone -------------------------------- Pho ___ Address iR � __ - Z- ------- ------ t1 ----- Q0��'-------------- - _ _ - .. _. _ff_f -�f - Cr, ---------.Phone---5/ Contractor's Name--- �u___�_,�--__-.-- ; 1_ -y _ ti Installation will serve: Residence �� Apartment House❑ Commercial ❑- Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: Number of bedrooms Number of baths [A Lot size__ ------------------- ` Water Supply: Public system Community system E] Private E]Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam ❑ Clay El 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 found tion--- 9. r�� Ma#erial_0,&Vwf&:f 17----------- ,� No. of compartments------ O------Capaci+y__�_d_0_�T1�'_�_Si,e___ l f.�_ ]_Liquid depth- - --------------- Ces pool: -Distance from nearest well_________________Distance from foundation-----_--------------Lining material-------------------------------------- 0 _____-___________--_-___________--__.❑ Size: Diameter------------------------- -----------Depth------------------------------------ -------------- Privy: Distance from nearest we11-------------------------------------------------Distance from nearest building------------------------------------------ See❑p g Distance to nearest lot line----------------------------------------------- a a Pit: Distance to nearest well________________ Distance from foundation_____ _____-__'___-Distance to nearest lot line_________--______ Linin material------------------------Size: Diameter-----------------------.Depth-------------------------- ❑ Number of pits-------------------- g Dispos I Field: Distance from nearest well____ '"___.Distance from foundation----- i ---__ ---Distance to nearest lot lirle__a ____"___._ Number of lines__*-1_We-________pp_"____. Length of each line_/�/�____ c� Width of trench-_4'_______________________ Type of filter maDepth of filter material 9 - J iJ material______ := 1 d �1-l-`J-l--€--'-r-�__ Remodeling and/or*repairing (describe): a � f � -�1 --- --- ------------ ------------- : ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ -_-\ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta �+aws, and rules n regulations o he San Joaquin Lo Health District. C { Si ned �_-`- { ? - - • � � ----------(Owner for ntractor)' (Signed) �- , , ter BY------------ --------- ��4- - -- ------------- Six --- ----- (Title) (Plot plans, showing size of lot, location of system i relation to wells, buildings, etc., must be fle with this application), i FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY C------------------------------------------------------------------------------------------- DATE_9 ------------------------------------------------- REVIEWEDBY----------------------------------��_ ---------------------------------------------------------- -------- DATE 2 BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------- - Alterations and/or recommendations--------------------------------- ------ ---- -- --- ------- ------- ---------------------------•---------------------- ---------------,r'.. ---------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------"---- { ----------------------•----------------------------------------------------•-•----- 1 ------------------------------------------------------------------------------- -- --------------- ---:-- -�-�----------- iSSUED__�_�-'`�/-_____-----__{Date} FINAL-----------------------------------------•-------------- --------------------- ---------------- �y �/ PERMIT No. / INSPECTION BY-------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ' ' E5-4-2M 4.50 W-1634