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APPLICATION FOR SANITATION PERMIT y "'t, 3 i (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 awith County Ordinance No. 549. .,,� 4r JOB ADDRESS AN OCATION---------- G� ---- -C r ---------/,:' r '' ------------- _& i ,r� �/ M' Owner's Name------ -----U-1-'�-Y---9[_./-�'--•-----------i------ r �__------ �� _ �_�.�� ------- - ------------------- Phone--- Address________________ Contractors Name__._1 __a____ Phone_ �'! ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other Ela f Number of living units: Number of bedrooms = Number of baths [I Lot size__ !..--- -l�--------------------- Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand E] Gravel ElSandy Loam ElClay Loam ElClay El Adobe Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permit+ed if public sewer is available within 200 feet.) " Septic Tank: Distance from nearest well-------__________Distance from foundation_-__-__________-_.Material__.---_________-________---______________-___.- ❑ No. of compartments------------------------- CapacwtYt, � �� Size_-------------------------------Liquid depth-------------------------- �1 Cesspool: Distance from nearest well-----------------Distance from foundatioon�___-_______-.Lining material____________-___________________--. ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- 'Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------________---___________--_--------- ❑ Distance to nearest lot line------------------------------------------------ ` I Seepage Pit: Distance to nearest�w/ell _ If .__ Distance from foundation--- -1------ to nearest I t line__ . __i Linin material__ /�1_'��_/ Size: Diameter__l_,�_��_______.Depth_. -�______________ Number of pits_.6_�Y_ __ g +.< GItC nDistance.from,foundation_% __:_-......Distance to-nearest,lot, line--2-6- Disposal ine__ ____ Dis osal Field: Distance from nearest well- _ � ��p _Numberof lines__-_�__�'�-r-----------Length of each line___Z�.�_": .________Width of trench___ ____ _ _________________Type of filter material__ i�_tK___--.-Depth of filter material____ �r__-- Remodeling and/or repairing (describe):------ 4%! -i -L`�_ _1Z/_��l-y_4--- ----------------------------- -----------i ----------------------------------------------------------------------- ---------------------------------------------------------------- ---------------•----------------------------•---------I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, S laws, and rulesegulations of the San Joaquin Local Health District. (Signed / : �� t� __�? �.: t --''<" ----(Owner and r Contractor) Ely:--------t (Plot plans, showing size of lot, location of system in relation to ells, buildings, etc., must be filed wv h this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ---------------- ---------------------------------------- DATE-------------- r �� (;�-��----------------- V -------- REVIEWED BY---------------------------------------------- DATE --------------------------------- -- ------------------------ BUILDINGPERMIT ISSUED--------------------- ----------------------------------------------------------------- DATE"----------------------------------------------------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------•------- ----------------------------- f ---•---------------------------------------------- --------- - ---------------------------------------------------------------------- -- - --------------------------------- -------------- i nn{ PERMIT No� '--J/-------- ISSUED- °-- ° d /--------(Date} FINAL INSPECTION BY:---- ---------------------------------- Date--------------------- ---------------------------------Date--------------------- (------- ------------------------- . � 4 i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California !ES-9—•-2M 9-50 W=1639