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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 application is made in compliance with County Ordinance No. 549. JOB ADDRESS-AND LOCATION------------7e4f --------- � Owner's Name--------------- ► � ------------ ------------------- Phone-------------- ----------------- Address__... 1d�l SrIFi_ --- Contractor's Name------------- -----www9 -'-- ---------------- __ Installation will serve: .Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: $ Numbertof bedrooms [U Number of baths [] Lot size_________�_i� __ tis __ "" R' ------- Is .0 a ----- Water Supply: Public system ❑ Community system'❑ Private JK t Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam E] Clay Loam El Clay El \Adobe K Hardpan V 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 _____________________"_ ❑ No. of compartments---------------------r----Capacity-----------------------Size-----•--------------------------Liquid depth.--------------- esspool: Distance from nearest well---(-" ..... .Distance from foundation_____/0"_ _.Lining material-___- Size: Diameter---------jt_�C_ -------------De th----------- �'Privy: Distance from nearest well_____________________ ____ ___-------Distance from nearest buildin ❑ Distance to nearest lot line----- Seepage __-_See a e Pit: Distance to,nearest we11______________________Distance from foundation__!_____-____-__.Distance to nearest lot line__-____________ ❑ Num$er of Pits------------------------Lining material-------- -- - - Sizer`Diameter Depth Disposal Field: Distance from near'est-weil_�______-----_'Distance from foundation--------------------Distance to nearest lot line________.________ ❑ Number of lines--------------------- ------Length of each`line---------- -------- '.Width of trench-----------------------------"__" Type of filter material_________________________Depth of filter material__k-___________-__-_:__ Remodeling and/or repairing (describe)_____________' ---------------•----------------------- ---------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- 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)------------------- ��j �--j ! _-__(Owner and/or Contractor) By:-----------�-`-�-�_�..-�►--1'---•11-------------------------- ------------- ------------- ----------------------------- -Title-------------- "��,.. M_% _________ ------------------------- ------------------------------------------- --- ------- )---------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc:, must be tiled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______ __ __ ___ ____ DATE____________ 4 ------ ------- REVIEWED BY--------------------------------------- ----._ DATE-- --- -- -- ------------------------------------------------------- ----- ---- ------------ UILDING PERMIT 15SUED__ DATE------------------ -- ---------------------------------------------------------- Al+#rations and/or recommendations__________ -------------------------" _ ---------------- - ---------- ----------------------------------------- - -- - IL -------------------------------------------------------•----------------------- ----- ------------- : :------ ------- -------------------------------------- --------------------- ----------------------------------------------------------- ---- `'--------------- PERMIT No.__ Q. CJ I ------- ISSUED------- -- --J-_6- -- ------(Date) FINAL INSPECTION BY:------------- - --' _- ------------ Date--------------- n SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street B-9-2M 9-50 W-1539 Stockton, California