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e � 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 . 549. JOB ADDRESS AND LOCATION__ __ _ _ __ ------------------- ---- ----- ---------- - ------ Owner's Name----- _t ---------------------------------------------------- ---------------------------------- Phone------------------------------------ Address---- /d - - -•------------- '� - ------------- ' c -------------- Contractor's Name_.-- A-�-*--•--- --- ----------------- - Phone--2_—'.9IIr /�------- Installation will serve: Residence ❑ Apartment House ❑ Commercial 15h Trailer Court ❑ /Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms ❑ Number of baths V Lot size ---_______________________________ Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clayx Adobe Q' Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: y (No septic tank or cesspool permitted if public sewer is available within 200 feet.) If Septic Tank: Distance from nearest well------- ------Distance from foundation------ --------Material-------- ____________________ _____________ a No. of compartments--------2------------Capacity----9W?--------Size_-- depth---- Cesspool: ` ---- Distance from nearest well_________________Distance from foundation------------------- 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____ _ til Ise Number of pits__.____�___________Lining material___--___.Size: Diameter_.___------------Depth------ -. ___________________ Disposal Field: , . Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- ` ❑ r Number of lines_______________________________•__Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material__________________.___ Remodeling and/or repairing (describe):Zx_41-_ A _ ,(�-----ext --�� .................................. t ----------------------•------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. (Signed)--- ' ----ZCI__�----`-�sOIL--------------------- -1�d/or Contrect6e 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 APPLICATIONACCEPTED BY-- ---- ------------------------------------------------------------ DATE--- ---------------------------------- REVIEWEDBY-------------------------------------- - --------------------------------------------------------------------------- DATE---------5;'---------'--------------------------------- BUILDINGPERMIT ISSUED--•--------------------------------------------------------------------------------------------------- DATE----------------%� ------------------------------- Alterationsand/or recommendations------------------------------------------------ ------------------------------------------------------------------------------------------------------------- -------------------- ------------------------------------------------------------------------------------------------------------ -----------•-----------------------------------------------------------------------------------------•------- ------------- --------------------------------------------------------- ------------------------------------------------------------ ----------------------------------------------------------------- - --- ISSUED----- /! r------------(Date) FINAL INSPECTION BY:--------w ----------------------------------- PERMIT No.__,�---� - - - -- .2�-�- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California �, ES-9-2M 9-50 W-1639