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r1 APPLICATION FOR SANITATION PERMIT q 1 Vp (Complete in Duplicate) 1 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. JOB ADDRESS AND LOCATION----------------------- 114 w, -------------------------------- Phone-----N-0- -------------------------------PhoneN-0-N& Owner's Name------------------ D-- lA Iq4 �A----------------------------------------------------------------------- --------------- Address -------------------------- -�J / Contractor's Name_______________ ____ --------------- .�-.! � �� f_�Ot.Cfr_�17_G�-.--------------- Phone--- -s'��x�1-�--------- Installation will serve: Residence X Apartment House F1 Commercial E] Trailer Court ❑ Motel [:] Other ❑ Number of living units: % Number of bedrooms j Number of baths d Lot size____O_Q'X__/ Z4------------------------- Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loam ❑ Clay Loam[I Clay E] Adobe Hardpan E] 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation_________--------------------------.Material------------#------------------ ............ ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth_------------ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining materia$_________________-__________-______. ❑ Size: Diameter--------------------------------------Depth--------------------- ----------------------------- .Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ El Distance to nearest lot line--- -------------------------------------------- Seepage Pit: Distance to nearest well__lr QNE-___Distance from foundation4---------.Distance to nearest lot linedr _,�0________ of Number of pits_ ____._______ -____Lining material —AA �-----Size: Diameter___,.��'�________.Depth____��_ rl1 -_�_---."______ Dis.posaI-Field: Distance from nearest well------------_----Distance from foundation_---______________.Distance to nearest lot line___:__= �i Number of lines-----------------------------------Length of each line------------------------------Width of trench------"------------- -------------- �' Type of filter material-------------------------Depth of filter material_______________________ Remodeling and/or repairing (describe):__________ -- c , ---- ----------- -- - IrRa.1-r------------------------ ----------------------------------- -------------------------- --------------------------------------------------------- -------------------------- ----------------------------------------------------------------------------------------------------------------------------- hereby certify that I ha pared this appl' . n and that the work will be done in accordance with San Joaquin County ordinances, Stat law nd r les an regulations f the Joaquin Local ealth District. (Signed)--- R/�1/5_f --"� �/J�t j --•----------- ontractorl ' �`7�ear_- 11�/ ---------------------------------------------------- --------- ---------------- Title) (Plot pl ns, sh win si f lot, location of s em in relation to weAs, buildings, etc., must be 4Ied with this application]. FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY----- ------- --------------------------------------------------------------------------------- DATE --- <---------------------------------------------- REVIEWED BY------------------------------ DATE------.. ------------------------------------------------ -------------------------------------------------------------------------- BUILDING PERMIT ISSUED---------------- ------------------ -- -------------------------------- DATE--------- —------------------------------------------ Alterations and/or recommendations------------------------------ --------------- -----------""------------------------- - -----------------------------------=----------" ------------------------------------------------------------------- -------------------------------- ____________------ -------------- __________________-"__________-____.._--________-______----"_________-___-- ------ G , PERMIT No._ -- --- __"-- ISSUE0. j.J -------(Date) FINAL INSPECTION BY--------- ------ ---------------------------------- r"""" Date-------- --------- 1--------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California —9-2M 9-50 W=1639