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APPLICATION FOR SANITATION PERMIT 7 i (Complete in Duplicate) 3 7 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 LOCATION0 __ !�!JDG - ---------------------------------- ✓ ---- All-, ----- ---- Phone /-, U. _. Owner's Name------------------------ ----------------------------- Address-------------------------------- -----_--------------------- Contractor's Name--• ------- --•--•----- --------- - —----/ Phone------------------- --------------- Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence [� Apartment House ❑ ❑ Number of living units: ( Number of bedrooms � Number of baths [6 Lot size--------- r __ -- ------------------ i Water Supply: Public system Be'Community system ❑ Private ElClayAdobe� Hardpan Character of soil to a depth of 3 feet:� Sand ❑ Gravel F1 Sandy Loam ❑ Clay Loam E] Clay ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: CN (No septic tank or cesspool permitted if public sewer is available within 200 feet.] n� a�p — Septic Tank: Distance from nearest well�_�---Distance fro foundation___ .______-.Materi I_..._�-�.___._...___ _ 8 a'KSize_. }C __ .Liquid depth------ ------------ -----Capacity-, J 1 No. of compartments......... .......... -- Cesspool: Distance from nearest well.................Distance from foundation------------....-...Lining materia.-.._.--__-.___.__.-_-_____.- ❑ Size: Diameter-------------- ----------------------Depth--------------------- ----------------------------- Distance from nearest building ------ earest well------R----------------------------------------- -------�- ---------:------- --- Privy: Distance from n ❑ Distance to nearest lot line---------------------------------------------- Seepage Pit: Distance to nearest well____- -Distance from foundation--------------------Distance to nearest lot ine....___-...__.. ❑ Number of pits------•---------------Lining material'---- ---- - Size: Diameter-----------------------Depth-------------------------------- Distance from foundation_ ._� --------Distance to nearest lot line_/_' _------ p Number of lines------ -•--f� ` ---_-----/�` -------------------- L Number of each line---------- --------------Width of #Tench__..._-. - Disposal Field: Distance from nearest we - T e of filter material _ �' - --- Yp �__-. �f]epth of filter material....-_«----_--- It Remodeling and/or repairing (describe)------------r--------- ------------------------------------- ----------------•-----------------------•---------- -- ------------------ ---------------- ------------------------------------------------------------------ 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. / t F - µ-------------------- (Owner and/or Contractor] ✓ Si ned - ( 9 -- ; ----------------- --------- -------------- ----------------------- - ------------- gY -------- -- ------ ------------ (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 _r7Z --- PATE_= '= - f---------------------- - APPLICATION ACCEPTED BY................�--�--{�'-�-�s'' REVIEWED BY------------------- --------------•--------------------------------------------- ----------------------- `_: ---• DATE----------------------------------- ----------- ----- BUILDINGPERMIT ISSUED------------------------ --------------------------------------------- -------------- Alterations and/or recommendations:________. ----- -------- - -------•------------------------------------------------------------------------------------------------------------------------- --------------- -------------------- --------------------- ----------------------------- A--- Date Date FINAL INSPECTION BY:----- -11�--------- PERMIT No. --------- ISSUED --- �'� I 1 ------------- - - f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E$-9-2M 9-50 W=1634