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iY MTLICATION FOR SANITATION Kki.i T (Complete in Duplicate) Application is hereby made'k o the San Joaquin Local Health District fora permit to construct and install the work herein desc abed. This application is made in compliance with County Ordinance o, 49. � JOB ADDRESS AND LOCATION.. ------------- Owner's Name_. ---------------------------------- -- Address Phone_. ----------- --------- Contractor's Name---- --------------------------------------------------- ame---------•--____i -------------------------- -- --------------- - -- - - nstallation will serve: Residence Apartment House ❑ Commercial Phone ______________ ------•-- I Number of iiving unite: Number of bedrooms ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of baths [ -Lot size--------- r Water Supply: Publics stem .firr-� ------------ ' Y ❑ Community system ❑ Private � -- Character of soil to adepth ��f 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam �] Clay r TYPE OF INSTALLATION AND SPE Y ElAdobe(HardpanE]CIFICATIONS: (No septic'tank or cesspool permifted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_____Q-_L__r__Distance fr .f undation_______ t No. of coipartmenfs----__ -_ ------Material--- Mep, Capaaty------ _!�_ Size_Cess ool: -I--51-- L qth-----.----- ❑p Distance from nearest well_________--------Distance from foundation Size: Dia -1ining material mafieriai____-______-.______. meter__________________ �E Depth Privy: Dist __________________ _ Distance from nearest building Distance from nearest well -------------------------=---- Seepage Distance to nearest lot line..... _ _ ' age Pit: ❑ Number t nearest well-____________________Distance from foundation_______- • ______.___.Distance to nearest loft line______________.. p+ s. Lining fmateriaL Size: Diameter Depth ------------------� II - Disposal Field: Distance from nearest well-___--/__-_.Distance from foundation__-- _ f __.____Distance to nearest lot lin _._ Type of filter lines-----------�------------ - Length of each line_ 3�a 3! - T e -- �----.�-_�-- ----- Width-of trench------------ Depth ofer materiaL._ _�-.. ut� -Depth of filter material.__..______ -Remodeling and/or repairing (describe)_________________________ ,1 ------------------- -----------------•------------------------------------------------- ----------------------------------------- •-----------------------------------•-------- -------••------------------------------------------------------------- e It ce that I have prepared this ns ofapplithe and that the work will be done in accordance with San Joaquin County ordinances St a aws an ,i � drrules and regulations of the 5 Jo � f � Local Health District. (Signed)-•-- s� i. urn ✓y E �= ------------------ ----- --------------------- !Ler and/or Contractor) Plot laps showing size of to+, II ------------- ------------------------------------------------•- -(Title)_ ocation of system in relation to wells, buildings, etc., must be filed with this application). ry F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.iM------_.:.-- - i REVIEWED BY 4 DATE d :BUILDING PERMIT ISSUED_.-----�I----------------------------------------------- ------- DATE___---��:�_�..�--------------•-----•------ 'Alterations and/or recommendations:--------------------0___ D ------- ATE ----- -------------------------------------- - ----- -------- i ----------•-- •--------------- 5 ---- rZ' -------------- "PERMIT No._-/;�----_-_ _ ISSUED.... lC_---------------------------------(Date) FINAL INSPECTION BY:--------- -----------?_ . _ Date ( - _ --•---_----- I`.. SAN JOAQUIN LOCAL HEALTH DISTRICT l 130 South American Street r FS--9-2M 9-50 W4639 Stockton, California I I '