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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 o. 549.. ------------------------------------------------------ JOB ADDRESS AND _ _r - LOCATION__ --- ---- ---------- �p .• Phone------------------------------------ Owner --y---- - ----- ------------------------ --------------------------------- Owner's Name____ ,,�_C..t f t `5 -- ----- - ---------------------------------- Address-----•------------ Contractor's Name---: --r A - - - t:-'�-` __��'- ------ ------- -- --- - Phone--�----�-�-�---------- -'------ Installation will serve: Residence 14 Apartment House E] Commercial ❑ Trailer Court El Motel El Other ❑ ---- -X � - -�-tea--- ----------------- Number of living units: 11 Number of bedrooms EP Number of baths [J Lot size____G_. Water Supply: Public system ❑ Community system ❑ Private Cla Adobe Hardpan ❑ ��JJJ Character of sdil.to a depth of 3 feet: Sand ❑ Gravel [_1 Sandy Loam ❑ Gay Loam ❑ Y ❑ [f� 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--'quid depth-------------------------- 0 No. of compartments------------------------ Capacity_______--------------- Cesspool: Distance from nearest•well-----------------Distance from foundation______--______-----Lining material_____-_________-._______ ---------- ❑ Size: Diameter_____________________ __ --------------Depth---------------- y------------------------------ -Privy: Distance from nearest well________----------------------------------- _______________________ ___ __-___-____Distance from nearest building --------------- Distance to nearest lot line------------------------------- ==----�------ - Seepage Pit: Distance to nearest well --'n'n------Distaanl e from founds zie nDiameter:___D-stance to nearest lot line----------------- Seepage -------------- ❑ Number of pits-_ g 7 �� ..._Disposal Field: Distance from nearest well_,�e------.Distance from foundation____�.�--�--Distance to nearest lot ine__�_ Number of lines_____________ _ i -fLength of each line_______ -_-----Width of trench------- .- -- --------------- -- --- ------ -- --- Type of filter material___ _� -Depth of filter material __-_-_--- - -- k ______________________________________________________ __________________________________ ______________________ -Remod ---------------------------------eling and/or repairing (describe :_________________________ --__---____-----____ - --------------------- ---------- -- ----- - ------ - --- -- - - ----- -- ------- ---- -------- hereby certify that I have rules dula s ap olf thtion e Sannd JoaquinhLocalkHealltheRistriecfn accordance with San Joaquin County ordinances, State laws, and r re4 - 40wner.-and /or Contractor) Signed)--- •------ -------- ---A. �� 7 - ----- ----'-- -- - - -------- ------(Title)- - __'�}�1 ------ (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 APPLICATION ACCEPTED BY v�# DATE------------------------------------------------------------ ___----`_---- ------ --- ---------------- REVIEWED BY------------------------- ---------- ------------------------------ DATE --------------------------- ---------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------ --------------------------------------------------- -- ---------------- Alterations and/or recommendations--------------------------- ----- -----------------------------------_--_-- ------------------------------------------------------------ ------------------------ ----------------- ----- -------------------------------------------------------------------------------------------- -------------------------------- --- --------------------------------- - r11 ----- Date FINAL INSPECTION BY:------V_j----------- ------------------------ -------- PERMIT No --t--i------- ISSUED----- ,•1 ' ---~--. ------------------�rf� — --'--�__------------------- Date___ � . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639