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i 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. I .-'-----------vs----- JOB ADDRESS AND LO TI N---------- --�--�-"--------- - �_ Awe_�e,-5------------- ------------------------- -- ' f av�---- ---- -- - - - r1 `_ -------------- Phone------------------------------------ Owner s Name:____________________ --- --- Address------------------------------------------------------ -�-- --------- - --�-�-------- -�- - ----------------- Contractor's Name ----------------------------------- ------------------- - ------------------------------------------------------------ Phone Installation will serve: Residence � Apartment House ❑ ommercial ❑ Trailer Court ❑ Mote{ ❑ Other ❑ * ' p �� ------------------------ Number of living units: Number of bedrooms umber of baths «• Lot size__________________ ____ ` Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam E] Clay Loam El Clay I] Adobe[Hardpan [�/ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) --�Vlater�a I-------- +t> --------- Septi --------------4----------1K c nk: Distance from nearest well --"-_,Distance fro foundation_.___ --- j ., a. ----Capacity------ 40 Size--- -XAF Liquid depth . t No. of compartments______________________ 011 Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining materia-___________---__________---_ ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- , ---------------------Distance from nearest building------------------------------------------ El Distance from nearest well___________________________ - ❑ Distance to nearest lot line------------------------------------------------ ( r x-Q----__Distance to nearest to lin_-- -_---- Seeps Pit: Distance to nearest ell------—'____-__Distance f m fo ndation-___ e th - Number of pits_________ ___________Lining material_�`l��lrM �ize: Diameter__�.X, p ,� - 1�___ ___.Distance to nearest lot [in 7_ ____ ____.._ Dispos ield: Distance from'nearest well---- `_:__Dis+ante from foundation__-_ I Number of lines---------------I-------------- --Length of each fine-------------5a--------Width of trench----------- _------------ �`'Type of filter material_,-1 -: __� Depth of filter material-_____ E___-_-_-_ rl� r -------------- Remodeling and/or repairing (discribe): _ --------------------------------------- -------------- ---- = --•------------------------------------------------------------------------------------------------------------------------------- 1 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. a --------------(Owner and/or Contractor) -. By:---------------------------------------=------------------------------ -------------------------------------------------------------- (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--------- - T ---- '------------ DE_- --� � ---'" ---------- ---- REVIEWEDBY------------------------------------- ------- ------------------ A-------------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- DA Alterations and/or recommendations------------------------------------------------------------------------------------- ------------------------------------------------------------------------- -------------•------------•-------------------•----------------- •-------------------------- --------------------------------------------------- - INSPECTION BY:--------------------------------------------� ----. ---- - PERMIT No._-,�__L- ----------- ISSUED____.--'!-- --=a (Date) FINAL1 i ---------------------------------! -------- pate-------------�.� ��-� � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639