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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:a lication-is_mad'e_`i_n,cgmpliance Co y Ordinance No. 54 C u r c-i..��aC y_____u�c.e-_ ___________________ 5 JOB ADDRESS A D L CATION___ -_ - - ----- - . '-•---- -- ----- Owners Name---" - -- r -- ------------------------------------ Phone------------------------------------ Address-_ - - ------ 9,&-/ -- - one --- - -- �_ G,.. , Ph - --- Contractor`s Name-10- - Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms ❑ Number o baths-2Lot size------ ��--x- ------- Water Supply: Public system . Community system El 1-1Character Supply: soil to li depth o 3 feet: Sand ❑ Gravel F1 Sandy Loam ❑ Clay Loam ❑ Clay ❑� Adob Hardp 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___________________-_______________________-___. F1 No. of compartments-------------------------Capacity-----------------------Size--------------------------------Liquid depth -� Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining materia------------------------------------ ❑ - Size: Diameter----------- ---------- ---=--Depth--------------------------------------------------- -------------------- ----Distance from nearest 'building------------------------------------------ Privy: Distance from nearest well__________________ _ _ ❑ Distance to nearest lot line____---________________________________________ w _r__Distance to nearest lot line___l0- See a e Pit: Distance to nearest well--------- from foundation____ Number of pits____` _---------------Lining material_ r_Size: Diame#er___- r `"--_Depth---� ---43- Disposal Field: Distance from nearest well-----r___.Distance from foundation___��----Distance.to nearest lot line____ - ` Number of lines-----------I---- -li Length of each line------��o--`--------------Width of trench-------- -�1--'-'--------------- k Type of filter material__ ----Depth of filter material------- f y - - - ---------------------------- . Remodeling and/or repairing;(describe}_________________-_______________-------------- - ----------------- ----------------------- - ------------------------------------------------------ --- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin aunty ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----PIA,---- - p�es_"djor Contractor}--G��' _ _`.1�.- -`�'�'�- --------- -------------------------------------------- ----------- -------( Y " - -- ---- ------------------- --------(Title} � F (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 11 - DATE---- L3I r --------------- APPLICATION ACCEPTED BY-------- I/- DAT1= REVIEWEDBY--------------------------------------------------------------------------- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------ ------------------------------------ Alterations and/or recommendations_______________ __ _ t� �� y ---------------------------- ------------------------------------------------------------------------------ ---------------------- ------------------------------ -------------------- ---- ------------- ----------------------------------------- ------------------------- t: ----------------------------------------------- ----------------------- --- ----------------------------------- - - [Date FINAL INSPECTION BY--------------'41----�------------------------------------- '3't' ------- ISSUED---------- ---- -----_ } ... ..- PERMIT No�------------ .-- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639