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APPLICATION FOR SANITATION PERMIT 7 (Complete in Duplicate) rs 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. I JOB ADDRESS AND LOCATION `f�-----------sa,--vtW----------` /-1 -C I ------------------------------- Owner's Name-------►1lh IR,.---. ------------------------------------------------------------ --------------------------------------- Phone------------------------------------ Address------------------------- Contractor's -----------------------------------Address------------------------ Contractor's Name---------------13.-Q L-jq-AL[)-- Phone ------------------------------------------------------------------------ - Insfallafion will serve: Residence ❑ Apartment House% Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Number of living units: Number of bedrooms [ Number of baths A Lot size___- 43_ -___ g / 4---------------------------- Wafer Supply: Public system K Community system [❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam fl Clay ❑ AdobeJ5 Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesf well-----------------Distance from foundation--------------------Material.-.-_-------____---_-_------------- ❑ No. of compartments--- ----------------------Capacity-•---------------------Size-------------------•------------Liquid depth-----------------------4 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____-----_____-___ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: -------------------- -----------------------------Privy: Distance from nearest well------------------------------------------------Distance from nearest building-----------------------------------------. +� ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest w II___--___- -___Distance from.foundafion---_____ _f Distan'e to nearest lot line-__ t --- Number of pits_--------�-------Lining material--- Diameter---.��_ Depth------�-1�----------------- i Disposal Field: Distance from nearest well-----�-_---.Distance from foundation------ ___--pistance to nearest lot line��-_--_:__- Number of lines-------------1-__--_-___-____----Length of each line-------4--°-.'Y-70-Width of trench------- •_'cif-_--------_---___ Type of filter material---J�-- 4-.+_ __Depth of filter material'-_----� •e r L t Remodelingand/or repairing (describe):--------------- \\ ----------- ------------------- =-- --•------------------------------------------ ----------------------- --- --------------- -• F -------------------------------------------------------------------------------------------------------- -------------•-------------------------------------------------------•-----•---- ------------------------------------------------------------------------------------•-------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ---------------•---------------- hereby cerci th61hnave pre red this application and that the work will be done in accordance with San Joaquin County ordinances, S.ate la , les nd' egulations of the San Joaquin Local Health District. 64 0 (Signed)- y f � ----------------------------------------- - -------------( er and/o. Contractor By:•------------------------------------ ------------------------ -------------------------------------------------------------------(Title)--------6111t � ------------------ ' (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). " k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- -- -------------------------------------------------------- 7-;--f-;DATE-------------- - - REVIEWED BY-------------------------------------------- ------- - -- ------------------------ ---- - - ----------- DATES ,BUILDING PERMIT ISSUED------------------------------ ----------------------------------------------------------------- DATE------------------------------------------------------- -.Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------=-_----------------------------------------------------------------------------------------------------------------------------- -------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- _- -------------------------------------------------------------------7-- -----------------------------•---------------------------------------------------------------------------------------------------------•----------- y PERMIT No.-76- t--------- ISSUED-------- ----tF - 1---------(Date) FINAL INSPECTION BY----------------------------------------------------------------- Date--------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street - Stockton, California ES-9-2M 9-50 W4639 t