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/ZU APPLICATION FOR SANITATION PERMIT �j (Complete in Duplicate) Application!!!! is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her described. This application is made in compliance with County Ordinance No. 9. JOB ADDRESS AND LOCATION---- �__ -------- ______ __ __ __ ___ _____-_ _ -------------------------------------------------------------------------- ft Owner's Name -AA - Phone------------------------------------ -------- -Address--g-0-1- 4---A -=, ddress--- ° - -1-�--- - • ------ --------------------- --------------------------------------------------------------------------------------------------------- ------ Contractor's Name--- � �---C ----4-4- ---------------------------------------------------------------- Phone---V"-- S71 7----- installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [ Number of bedrooms 2- Number of baths 0 Lot size__-47W Ir----x --------------------- Water _ __ __Ir__- Water Supply: Public system Community system ❑ Private ❑ N-1. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑-,,Q 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--------------------Material_____________________________________-___-_---.. No, of compartments--------------------------Caacit ----------Size-----------------.--------------Liquid depth--------------------------. Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material------------------------------------- Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- El ________________-_-_--- -____❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well_____________________ Distance from fo dation_____ AA �0 _-___.Distance to nearest lot line--All?---- Seepage Number of pits__________-__-____Lining material�j__AW—Size: Diameter___i� ' ___`_�______.Depfh-�----''�--. Disposal Field: Distance from nearest well----m-,-_-__Distance.from_foundation____ ' f if to nearest lot line_-�� ___ ^� Number of lines______________I________-____-____Length of each line---------- ---------Width of trench - - ----'_____________ F ` Type of filter material _ pth of filter meferial__________1 Remodeling ands/or rep irin (des ribe}/{____._ ____ ,-_ -' -sd �/J^----- ------- - - '---------------- ---------------- 1 ......----- \ -------- 1--------- ---- =-`--=--a------------- ---------------------` ------ ------- .. - - - -------------------------------------------------------------------------------------------r------------------------------------------ --------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State,laws, and rules and' regulationsofthe San Joaquin Local Health District. (Signed) , � 1?�`'r`�'.r`' ------------------------------- 'Qdlor Contractor) 5i ned By:--- ?-------------------------------------------------------------------(Title)- .. --------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY ti APPLICATIONACCEPTED BY---------------------------- = ------I------------------------------------------ DATE----- ---' � '` ---------------------- REVIEWEDBY----------------------------------- -------------------------------------------------- DATE-----� � 7 '� ------------------- BUILDINGPERMIT ISSUED-------------- �, ",'c- 'r--- ------------------------------------------------ DATE------74""�---------------------------------------- Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------•--------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- r- �--_ --------------------------------------------- ------------------------------------------------------------•------------------------------------------------•-------------------------------------------------------------- PERMIT No.__Ir_0---------------------- ISSUED____—:77- 5-7-�--------------- Date FINAL INSPECTION BY:----- ---- ---- ------------------------------- Date---------- -----_------------------_--_--Date---------- ------------ --- --l--- ----r-; ----•---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639