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��. APPLICATION FOR SANITATION PERMIT l 0 (Complete.in Duplicate) Application is hereby made to the San Joaquin Local Health District fora ermit to construct and install the work herein described. This application is made.in compliance with County Ordinance No. 549. JOB ADDRESS AND LOTION--•--�- rr,------ - --- ----------- ----------------------------------•---•------------------- Owner's Name------ -- - ----- --- ---- -- ---------- --- -------------------------- -------------------------------------------------------------------------------------------------- Phone------------------------------------ Address_....__..... { d-- ___ -- -- ----- -- - -----------------------------------------------•,----------•--------------------------------------------------------------- Contractor's Name-------_----_- ------ --------------------------------------------------------------------------------- Phone----------------------------------- I Installation will serve: Resi ce Apartment House ❑ Commercial ❑• Trailer Court ❑ Mote[ ❑ Other [-I Number of living units: Number of bedrooms a Number of baths Lot size-----_!�0d------ ................ Water Supply: Public system Community system ❑ Private [] Character of soil to a depth of 3 feet: Sand ❑ Grave[ L]- Sandy Loam ❑ ,Clay Loam E]'-.':Clay ❑ Adob Hardpan ❑ v TYPE OF INSTALLATION AND SPECIFICATIONS: NJ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well-----------------.Distance from foundation--------------------Material------------------------------------------------- No. of compartments-----------------------------Capacity-----------------------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--____-_----__--__-------_-_.---__--____-. ❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__.._____________ ❑ Number of pits-----_----------------Lining material----------------_------Size: Diameter-----------------------.Depth---------__.-----------_.J--- i Dispos Field: Distance from nearest well__ ___ _______Distance from foundation _ --------Distance to nearest lot line_. _ a Number of lines____________ ____ -_ Length of each line___.. __ Width of trench___. Type,of filter material__ _. f Depth of filter mater:a� I___ �� } �i-- Remod' ing and/or repairing {des ribe):____--___ ________________ „r� r_ - - ---------------- - ---------------------- --------- ------ - -- -- ------------------ --------- - ------------------------=-`-------- ---------- --------------- -------------•----- -----------•---------------------------------------------•------------------------------ I hereby certify tha have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, an rul and regulations of the San Joa uin Local Health District. I (Signed)------- --- - -- - -- {- -------------------- ---- --------- ------------------------------------------(Owner and/or Contractor) BY: = ------- --------- (Title) ---------------- (Plot plans, showing si lot, loc ion o s stem in relation to wel s, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ E --------------------------------------------------- DAT ---- �- - REVIEWED BY------------------------------------------------------------- DATE ---------------------------------- BUILDINGPERMIT ISSUED-----------------------------------------------'--------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations----------------------------------------------------------------=--------------------------------•-----------------•------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ s --------------------------------------------------------- _ --------------- .-..____--__________________________________._.___________________ A__,R_---------------------------- PERMIT No ---- ---7 ------- ISSUED-----__-- ------_----- ----.5 Date FINAL INSPECTION BY:------------------------ __---------------------------------- Date----------------- � .r SAN JOAQUIN LOCAL HEALTH DISTRICT s! 130 South American Street Stockton, California ES-9-21A 9-50 W-1639