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, -- T ' I APPLICATION FOR SANITATION PERMIT ; (Complete in Duplicate) - - —. , Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins#all the work her describe ; This application is made in compliance with County Ordinance No. 549. d' , JOB ADDRESS AND LOCATION---- Owner's Name --•--------------------- - = ----- -- ---------- ---------------------------------------------------------- ------- ----- --- •--------- -- r� --- -------------- ------------------------------------ . ------------------------ Phone--A-2 q -Address r. -- i ---------------- --------------------------------------- on ractor s Name___________________ ___ - ----------------------------------- Phone------- `---------- - - - ------------------------------------------------- - Installation will-serve: Residence W1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms © Number of baths ❑ Lot size------ .?__"___� Water Supply: Public*system-0 "Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandyam ❑ Clay Loam ❑ Clay Adobe { Y ® Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if:public sewer is available within 200 feet.) Ii Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material ____"___________ ❑ No. of compartments ------Capacity----------------------Size------------------- Liquid depth-------------- ----------------------------- Cesspool: `Distance from nearest well_________________Distance from-foundation--------------------Lining material-_____-________--__________ „ -------- ------------------- ❑ "Size:,, Depth Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line_______________________ Seepage Pit: Distance'to nearest well___.____ 7 _____Distance from ,f, gdyt}on__-__f J__-_-_.Distance to nearest lot line____ Number of pits__________ ___________Linin material...... r f' 1 / Lining -- --- - ize: Diameter. __3------------Depth-----------/0- ----------- ` .Disposal Field: Distance from nearest welL____Sp/____Distance from foundation_____L'�_�____"Distance to nearest lot line____S_" Number of lines--- ----------- Length of each line----------7 ____""""-_y4/id'th of trench_-________ _y__��----- Type of filter material____'1__,,_,-`--,"� Yt _-"-Depth of filter material-_______0-r`�______ Remodeling and/or repairing (describe}__________ ____ fd�i� ? ----- �l/ -----•----------------- ----------------------------------------- -t----- ---------------------------------------------------------------------- ---- - • - --- -- -- - ---- - --- - --- - ------------ - - ---- --- ------------- ------- I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of fhe San Joaquin Local Health District. (Signed)----------- - •---- ------ -------------------------------------------- -------------------------------------------------------(Owner and/or Contractor) t BY: 49" �� l• (Tifle)---------------------------------------------------------------- �e �sysm - ------------------------------------- ---- ---- (Plot plans, showing size of lot, locationola#ion to wells, buildings, etc„ must be filed with this application). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------'-----------------------�� - --------------------------------------------- - - - DATE_---------- REVIEWED BY-----------------------------•--------------------------- - --------- ----------'------------------------------------------ '--------- ---------------------- -_ DATE------ -- -- --- ----- ----�-- --------------- BUILDING PERMIT ISSUED--------------------- ----------------------- DATE---------------- ------------------------------- ------------------------- aerations and/or recommendations:__ __ ._____. -------------------------------------------------------------------------------•--------------------------------------------------------------------------------•--------------------------------------------- ------------------•--------------------------------------------------------------- -------------------------------------- -------------------------------------------------- ------------------------------------------------- --------------------------- ----------- �. -------------------- PERMIT No.___!�� ---•-_------ ISSUED------------------------(Date) FINAL INSPECTION BY.-L Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9---2M 9.50 W=1639 Stockton, California