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APPLICATION! FOY"SANITATION PERMIT f U • (complete in Duplicate) 4- kation is hereby made to the-San Joaquin Local Health District for a permit to construct,and installthe wor s'application is made in compliance with County Ordinance No. 549. �/� k herein described. JOB ADDRESS AND LOCATION----------- ---------- A14 19 Owner's Name . _ - ------------ - _ -------e Phone-------------------- ' --------- A dress------------------------------------------ -- - --------------- --- - -------------- --- ------------------------------------------------------•------------------------- ---------------------------------------------- ontractor's Name____ - - ---------- - ,--.. - - ---- ------- --------------------------------- - ---- Phone------------------ Installation will serve: Residence 7_1 Installation House ❑ Commercial +' ❑ Trailer Court rd el ❑ Other ❑ h-� " r' Number of living units: ❑ Num of bedrooms ❑ Number of baths ❑ Lot size_______��'_�_-�' __� � L f Water Supply: Public systemEr Community system ❑ Private ❑ !r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay C A F � I ❑ y ❑ Adobe B--Hardpan ❑ { TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; Septic T k,cgdDistance from nearest well_________________Distance from foundation________.__________.Material-------------------------------------------------- C ___________-______ -------- .-of compartments------------------- Capacity ------------------------------ -------Size----------------- --• -------Liquid depth------------------------- 1 Cesspo� istance from nearest well�"'-"'-'--Distance from foundatiory/-- I Lining material__ 5 1 l �.�wSrze: Diameter ----Depth-------1-� g----------------------------------------- } 4 rwy: Distance from nearest well___________________________ ' � ------------------- istance from nearest buildin ❑ Distance to nearest lot line_ E ----------------------- Seepage Pit: Distance to nearest well_,dA.-j!t,#-__:_Dista e from fou tion_ .Dista e to nearest lot )ine__-/_�_-_-_- �, Number of pits---------- Lining materi I__n- Dis asal Field: Distance from nearest woll------------------ �4 +-Si : Diam ter__-__ - - - Depth---.- _ ,_ Distan from f ation____________________p'istance to nearest ❑ Number of lines----------------------------------Length of each line_------__-- lot line'(� Number of filter material-------------------------Depth of filter material_________---_- ___Width of french__ _--_---_-----_--_ Remodeling and/or repairing (describe)--------------- - --------- - --------------------------------- ------------------------------ C ----------------------------------------------------------------- --------•------ ---------------------------------------------------------------------------------------------------------------------------------------------------------- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and' re. ulati ns f ty �� Ibaquin Local Health District. (Signed)---- ----------------- Signed) y; �` -------------------- ___--_(Owner and/or Contractor) - ------------ -------(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-----------------_- REVIEWED BY. DATE_ ----------------------------- ---------------- / •-------------- Alterations -- --- --- -- ---- ------------- 7 BUILDING PERMIT ISSUED--------------- ------------ DATE and/or recommendations:___ - ------------ ----------------------------------------- .-------- ------------------- -------- -$�- r- • -------------- U I -------- ------- -- -- �_ i IV - -- � =_ moo_ __:_ ------------------- �r _ � �. • L1_•----- ISSUED-------- -•-l- -__�____�-_____{Date) FINAL INSPECTION BY:____.._-__ � . RMIT No 1 Date f ---------------- SAN JOAQUIN FOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California