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APPLICATION FOR SANITATION PERMIT C� k (Complete in Duplicate) l a, 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. f '-� JOB ADDRESS .AND LOCATI N___��__1--��----_--- - ---------- �--- -� - Owner's Name--------------- 1 ----- -------------- Phone------------------------------------ .. - -------------------------------------------------- --- ----------------------------------------------- ---------------------••------------------- Address---------------------------------- .. r Phone----------------------------------- Contractor's Name---------------------------- ----------- -------------------------------------------------- - --------------------------- -- .Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: V] Number of bedrooms i� Number of baths ❑ Lot size_____ Water Supply: Public system LC Community system ❑ 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.) __Material____-_ gt a� Septic Tank: Distance from nearest well_��1;7e.Distance from foundation____1_, _-_____. r{ , - - v Size__<''V -----Liquid depth-----"_--�----_-;__ No. of compartments____-_____2-- Ca Capacity �� __ _- Lining materia______________________ Cesspool: Distance from nearest well-----------------Distance from foundation ❑ , Size: Diameter--------------------------------------Depth--------------------------------------------------- 'Privy: Distance from nearest well_________________________ -----------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line___________________________________________-___ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_______________-_ ❑ Number of pits Lining material----------------------Size: Diameter------------------------Depth----------------� : Di sp sal Field: Distance from nearest well----- from foundation____—>h__--- Distance to nearest lot line�_�__-----_ l2 Length of each line-_3_4 �-- cA -_.Width of trench___�-�------------------- Number of lines______________ 9 •� Type of filter material-_5 -Depth of filter material ____,l_-�'- Remodeling and/or repairing (describe)------------------- -----------------------•----------•_------------------------------------- -•--------------------------------- --------------------------------- --------------------------------------------------- .�- ---------------------------- -------------------------------- ------------------------------- -------------------------------- -------------------- -� 1 pre is app f the San Joaquin - -- - l b -one -- --- -- --- -- ---------------------- - ------ --------- ------------ ------ ----------------------------------------- hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County's ordinances, Stat, an gs Local Health District. S'i ned (Owner and/or Contractor) ---- ------ -------------------------- ------------------------------------------------ A By:------------ ----------------------------------------- - -- Title - µ(Plot,plans, showing size of lot, location of system in relation to wells, buildings, ®tc., must be filed with this application). i F R DE�RRT �11 SE ONLY APPLICATION ACCEPTED BY__ -- - -�-- -- - ----- - -- - DATE DATE REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- {:: .. BUILDING PERMIT ISSUED-----------------------------------------------7------------------------------ ------ DATE--------------------------------------------------------- - Alterations.and/or recommendations----------------------------------------------------------------------------------- ------------------------- -------------------- ------------------------------•---------------------------------------------- y ----------------------------------------------------------------------------------------------------------------------•----------------------------------------------- --.------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------- -- - ---- PERMIT No2>-�---0----- ISSUED__ --- -�_-- --�--`1�.---(Date) FINAL INSPECTION BY:________ __ _ -------- ---- - --- ----------- jl= Date--------------- {d �� --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W_-1639