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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health Disl rict for a permit to construct and install the work herein described. This application•is made-in compliance with County Ordinance-No. 549. JOB ADDR�SS AN 'i�CATION--------- --- - -- �..1 ......................... / Owner's Name -J- ..-""--"---- , , 7f . .. Phone._... Address.........t /••-_.,..,t Y__ f� .,.,'S^'.. .._.. �Q I Phone.. ._ . Contractors Name-------------------- "-• •�---------�------- --- -- - 1,�J7 ----- Installation will serve: Residence Apartment House El Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: to Number of bedrooms 0 Number of baths � Lot size_ --� ••�-f�� Water Supply: Public system ❑ Community system ❑ Private4m Character of soil to a depth of'3 feet: Sand ❑ -Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan } 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 compartmen+s.........................Capacity................. ••__Size-•,.............................Liquid depth.......... --•-•--•----- Cesspool: Distance from nearest well.................Distance from foundation_.... .............Lining material,__. . ............ .............. _:� ❑ ? Size: Diameter.................. -----------------Depth----------------------- "--•----•-•- -------•---•- .'Privy: Distance from nearest well.......... ............. ......... -------_.....Distance from nearest building. ........-..-•• - -------------- ...__ ❑ Distance to nearest lot line. ----------------- --------------- --_------- i See a e Pit: ' Distance to ''nearest well... a,._ Distance om foundation J0........Distance to nearest I tI'e-,.... .,_... j Number of --------- p - ' -.Lining material-!�s'i! / `t --Size: Diemeter_.. ��___.___.Depth. ,,, "--_____. ._`___ Disposal Field: Distance from nearest well- --------------- Distance'frorK foundation---------- ,.......Distance to nearest lot line..._............. Number of lines...................................Length of each line__..._..............__...--..Width of trench--------- --._-,.----.... .. Type of filter material.................... ...Dept}:-of filter material___...' . Remodeling and/or repairing (describe): .._...�/�' 4 ---�•- =°tom ' r.:!_:.`'�'�L'e2G�-�" rte.............. lj------ t............... ................... iN _V_ . \ -,...._ . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Slaws, and rules d regulations of +h Sen J squin Local Health District y "� j'�- ------------_-- ------(a'�' and/or Contractor] (Signed)-"- "p_a ..........�... .�_� � .nom•-� .cam+--"- (Title) � 'E �. �Y: - (Plot plans, showing site of lot,location of system in relation o wells, buildings, etc., must be file with this application). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._ .. .....------• DAT7r7 REVIEWED BY---------------------- - DAT :...... . BUILDING PERMIT ISSUED----- ---------------......__ .. ................. .... DATE Alterations and/or recommendations:. ................••---........... .... ..................... """" ---"-"---""..........................•-... ....,-•----,...... .............................. ----- -------------- - .. ............. .-•••---------••--•- 7 -- --- ''f Date FINAL INSPECTION BY:,.... ........)J�1.--1�---------- ------••.. ......•••. PERMIT No._�!�_7........_ ISSUED----- �� Y... I } Date,.,_,.. --• .......r_�r �� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-21A 9.50 W4639