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j - 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---------- Y..� .-+---- &_t_i'!M S i -e=--! Owner's Name j ,sT:�: i'ti; 4 •_ •�.� _ - ------- ! ; -,� - 4 , Phone it—�.�� i ---------------- -- -------------------- - ----- ---- - - -- ------------- Address__ •: Contractors Name [-------�_i ti-�1-----'r 5 � ----------- Phone__ Installation will serve: Residence$ Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .O Number of bedrooms [2' Number of baths Q] Lot size__-__ ---------------------- Water Supply: Public system ❑ Community system le Private ❑ ' 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.) Septic Tank: Distance from nearest well-________________Distance from foundation--------------------Material __________________--__________ __________. F] No. of compartments--------------------------Capacity-----------------------Size---•---------------------------Liquid depth-------------------------- -Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-___________-_-___________-_________. _ ❑ Size: Diameter------------------ ------------------Depth---------------------------------------------------- i' Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____--___--_____________________________ ❑ Distance to nearest lot line________________________________________________ Seepage Pit. Distance to nearest well_------Distance from foundation-----r'��___Distance to nearest lot line_____ Number of pits " g a ^----------- Size: Diameter----- -----.Depth-------------- ------- -_-__Linin materi _________ ---� Disposal Field: Distance from nearest well_l4GAr.._`Distance from foundat _ -Q!_____.Distance to nearest lot lne___ __ Number of lines -- n I_ __ __________Length of each line_____LO-- Width of trench___�<__#'________________--___ Type of filter maferial__f_ ______ _______Depth of filter material______ >r?___________ Remodeling and/or repairing (describe):-- n - ------------------- --------------------------------- t;�., -- L1�e-� ----------------------------------J-- -- t -!]_��- --------- ---- -�------ --- ------ --------------------------------------------------------------------------------- ----------------------------------------------t ------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that aye prepared this appl• *on and that the work will be done in accordance with San Joaquin County ordinances, St e I ws, a1td 3ules and egulations f th San Joaquin Local Health District. ' "` f---- --- (Si9 ).-- �- - Owner an for Contractor) Y• - �Ti = '- ; ✓ ---------------- (Plot plans, sho in 3i e of lot�ation of systq in relation to wells, buildings, etc., must be fil d with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- DATE---- - ------------------------------------------- ---------------------------- REVIEWEDBY------------------------------- --------------------------------------------------------------------------- DATE--------- BUILDING PERMIT ISSUED-------- --------- --------------------------------------------------------------------------- DATE-------------------; .01 Alterations and/or recommendations----------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------- --------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------- ---------------------------------------- i ------ PERMIT No._- _____ ISSUED-,___7 • -d /� ��/�'i ----� -----�, ------ Date FINAL INSPECTION -- -------- ---------- --------------------------------- Date------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ` ES-9-2M 9.50 WA639