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APPLICATION FOR SANITATION PERMIT Ic (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permif to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESSFANC Tl N __� -----« - --------- -- - -------/--------------------L-----------------------------------------------------------Owner's Name- - ---------------- ------------------•------ --------- hone------------------------------------ - -- -- ---------- ---------------------- Address -------------------------------------------- Contracfor's Name------ Installation will serve: esidence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms 0 Number of baths q Lot size_____ Water Supply: Public system kCommunity system ❑ Private ❑ g Character of soil to a depth of 3 feet: Sand 11 ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe. Hardpan L] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _Li uid depth __-- _----' Septic Tank: Distance from nearest well_`-_______Distance from foundation____do______--------- __ No. of compartments____.._______________Capacity----- d rJ ____Sizes ,f-Material__ p f E Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- F1Size: 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--------------------------- Disposal Field: Distance from nearest well------""__--_Distance from foundation----- ul)-f----Distance to nearest lot i �-------- Number �___ Number of lines______________ Length of each line-------- � Width of trench-o,� -�'- Type of filter material___ __ _ ___Depth filter material___,--,�___________ 1 Remodeling and/or repairing (describe)------------ —IV -------------------------------------------------------------------------------------------------------•-------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------- --------------------- -------------------------- --------------------•------------------------------------------------------------------------------------------------------------------------------------------------=------ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State w , and regulations,of the San Joaquin Local Health District.(Signed)------- --- - - --------Frid. -------------------(Owner and/or Con actor) By:------------------ ---- ----- ---------------(Title)-- - ----------------------------------------------- ---------------------------------------------- --- (Plot plans, showing ze of I , I ion of s stem 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---------------------------------------------------------------------------------------------------- DATE-------------------------------------------- Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- -•---------------------------------------------------------•-----------•-•--------------------------------------------------------------------------------------------------------------------------------------------------- //1(-::;2'--(D,fej - ----------------------- ------ ------------------------------------------ 1. PERMIT No._� f--------_ ___-- ISSUED-------------- FINAL INSPECTION BY:---_----_-�--[1_---�"------------------------- Date---------------- — -�-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639