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.S J U APPLICATION FOR SANITATION PERMIT y 3 Z' (Complete in Duplicate) Applica#ion 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_ r JOB ADDRESS AND LOCATIIOeN-_._,,_.,t.___b-,'a----- ._��_-�-��.�...______...___ Owner's Name_.,/_'t/!(,et,•e-.--��,''/;._...?Q,�g-_____________-----..._.... -.---••--••------ _........ .,__........................ Contractor's Name---_D__d4__'y_... 4014eu Phone--,_.:: _......... _........ .... _ Phone__=__q__r�..__ Installation will serve: Residence Apartment House Q. o� ercial ❑ Trailer Court ❑ Motel [:1Other [INumber of living units:.) Number of be ' c, s � Number of baths [ Lot -------- Water Supply: Public system ❑ Community system Priv teX r Character of soil to a depth of 3 feet: Sand ❑ Graver ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe -x Hardpan -E] TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ... t f _-:+___ _.Distance from foundation______ ___......... Material --- C - -ti-S--- -------- - No. of compartments ___---- .�_.__Capacity ---- �'p-�-_••---5ixe.-_ai---_-- '..Liquid d$pth_..��•Z-�.',- .......... Cesspool: Distancs doom nearest well_________________ Distance from foundation_.. .... _........... Lining material ___.................. ........ ❑ Size: Diameter -........... -.......... ............. Depth----------------•-...-.... r, Privy: Distance from nearest well____________________ --------- __ __..__._______Distance from nearest building __....... ___.......... - ... ..__--_ .- Distance fo nearest lot line ....... _---------------_---_-....... __-_._ Seepa e Pit: Distance to nearest well ... J-0-0-__.____Distancefjro`m f ndation___._ ��-_.__Distance to nearest lot line ..... ;Vj :.___ IR Number of pits___._./..........__Lining material_�S:c�1_ ..Size: Diameter -.33-t.- Depth_.�.�_F ------------- _______ Disposal Field: Distance from nearest well__.,!__.Distance from founda+ion___._,,_t...__-Distance to nearest lot Number of lines--- ,_______-_._........ Length of each of trench-_ ---------- Type of filter materal_1�4__. ..... Depth of filter material_____ Remodeling and/or repairing (describe): ................. _•.-__-__-._._._.-_---___----••-------•-•-----•-- - ___....... --...... ..:_. _.:._.----------- __......... •---•----- -----------•------------------- -------- --------- -.... -•----•-• ------------------ -.----------------------- .. -- .._ ............. --....- 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. �} (Si ned Lf 9 B-- --�-- - �-- itlr5e----•---•--._.-.,,:_..>_...---=------°--.._..._._.._.._..--Tile----.__-•� _ ar Contractor) (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___ _... REVIEWEDBY.. ...... -------_------•------------------ - --------------....... _...._._._.... _-------------------- DATE _ - :._.._� _ - ------- BUILDING PERMIT ISSUED-__-„...:.................•-__.________._.__...a.-.__....._._------ DATE_-_-- ------ ---_--__._--- ---- -----_ Alterations and/or recommendations: _� _ _ _._.... _.... •.. - >------------.--------------- _------- --•-•-.......................................... PERMIT No._3. 51_.____-,__ ISS UED..__.__ , " ..__. ..... _(Date) .................... ------------------------------ .FINAL INSPECTION BY: .._____1V_. !i4------- ---•••---- ,�-._...._.. - Date__.. .......... � j SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES -9-2M 9-50 W-1639