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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) P P ) 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 Count %rdinance No. 549. . JOB ADDRESS A D OCA [ON____ zl----- ------I-- --------- -------- ---------------------- Owner's Name--- ----- Phone------------------------------------- Address ~ n --- -- --------- Address � -------- �+r E'-------.. --- -Yr --- Contractor's Name----� ----------------------------------------- ' ------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size___'_______________________________ -------------------------- Water Supply: Public system ❑ Community system ❑ Private ❑" I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ .Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,e Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material --________________________-__________'_____. Y r, ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth- ----------------- --- -Cesspool: Distance from nearest well-----------------Distance from foundation___________________Lining material------------------------____-________ ❑ Size: Diameter Depth ------------------- E1 "Privy: Distance from nearest well_____ _Distance from nearest building _ ---------------------- Distance to nearest lot line-----_________ C Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-________________ ❑ Number of pits----------------------Lining material_----------------------Size: Diameter------------------------Depth--------------------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- El ___- ___________ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material________________________Depth of filter material_______-.____-- + Rem•deling a Lepairing (describe):--A_ �_u - --- ------h�.t--- /l�0`5 .---7inaccordance _ --------- ----------------------------------------- .---- ------------------------- -------- ------------------- ---------------- ------ ----- - ------------•---------------------------------------------- ------------------------------------------------------- -------- a I hereby certify that I have prepared this application and that the work will be donwith San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----_ --2. .21--------------l ,r _ ----------------------------- ----------------------------------(Owner and/or Contractor) Sy:-------------------------------------------------------------------------------------- --------------------------------------------(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 APPLICATION ACCEPTED BY------- --------- ,�_; - DATE_ l in REVIEWED BY & DATE DATE fJ4- - ------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- --------------------------------- DATE- - I Alterationsand/or recommendations-------------------------------------------------------------------------------------------------------------------------------------------------------------- ` ---------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- --- - ------------------------------------------------------------- -------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- PERMIT No.-_ - ______ ISSUED----��-- �S/-----------(Date) FINAL INSPECTION BY: ----------------------------------------------------------- -_-W L) W- --- -------------------------- Date------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California F ES-9-2M 9-50 W--1639