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y APPLICATION FOR SANITATION PERMIT I (Complete"iw l)o Fate) . 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.wifh""County'Ordinaric(�,.N'o. 549 ` JOB ADDRESS AND. LOCATI I _ - S__-" `•has - -------------------------------------- Owner's Name_____ kL .1 - -=----- --------------------------------------------------- Phone-----__— Address------ ox �1 --------------------------------------------� I; "Contractor's Name-_-____ ____ - -- -- ------------------ -- ----- Phone- " �--- - ----------------- ----------------- ------------ - --- Installation Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo#el ❑ Other "❑ c s: " Number of bedrooms` Number of baths E] Lot size Number of living unit Water'Supply:,,Public system ; Community system E],.-Private T }:;�'' ` ., Character of-soil to a de tIr of 3:feet: Sand Gravel Sand Loam Cla " Loam: Gla. ,. p. - ��• " � Sandy ❑.: °. Y ❑ Y ❑. 'Adobe ❑ • •Hardpan E]- TYPE OF INSTALLATION`AND SPECIFICATIONS: (No septic tank or cesspool permitted"if public sewer is availa6le"within 200 feet) *• Septi Tank: Distance from nearest well _� _ -__� � Distance fr foundation________ --- _ • '""' No. of compartments___ ______________Cd acit �0_-Q_ Size________ / P Y --- X X/ Liquid depth_---=- ----.--- 3 YI .Cesspool: Distance from nearest welL________________Distanco from foundation-------------------- material------------------------- -- == ❑ Size: Diameter - Depth--------------------------- ------------------ Privy: - ``- Privy: Distance from nearest well-------------------------------------------------D stance from nearest buildin " ❑ Distance to nearest lot line - g Seepa a Pit: Distance to nearest well __ _G---------Distance fr m fou dation__________ _________Distjnce to nearest lot lin .�.� y. e Number of pits--____�___`______--_-Lining material _Size: Diameter____ + I ' �-------------- Depth--------� ------------------- Disposal � )' Field: Distance from nearest well___-�-�v-Distance from foundation____"':'--,_._.Distance to nearest to liin ____ i ° Number of lines_ ______ __ ___________ Len Length of each line___ \ ! g i: Width of trench------------------ ---------------- Type of filter materia _ ------Depth of filter material---r/ _---_._ ---- { Remodeling and/or repairing (describe):__________________ i ------------------------------------------- •---------------------------------------------------------- F. ----------------------------- --------------------- ---------------------------------------------------------------------------------------=------- ------------------ -------------------------------------------------------------------------------- ----------- I hereby certify that I have prepis application a d that the work will be done ' accordance with San Joaquin County ordinances, Iaws, and rules and re uI ti a oa in Local Halt Distr' . I (Signed)- ------ ' . ---------- -----(Owner and/or Contractor) By:---------- ---- - --------------I----------- - (Title)- r (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____ ' REVIEWED BY - -- --------------- BUILDING PERMIT ISSUED ----- ------------------------------------------------------------------------------- DATE------- --- ----- -- - ------------- - --------------- - ------------ - --------------- DATE------------------�--------- ----------- ---------------- Alterations and/or recommendations:- ______________ ---------------------------------------=--------------------------- - -=------- -----------------------------------------------------------------------------------------------------------------------------------•------------------------------_-------------------------------- --------------------- -------------------------------------------------------------------------° ---------- ----- PERMIT No.__4�--- ISSUED---- Date FINAL INSPECTION BY:------- -/ Date__ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street , f Stockton, California ES-9-2M 9-50 W-1539