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X19-3 APPLICATION FOR SANITATION PERMIT (Complete in Duplicatel 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. J08 ADDRESS AND LOCATION----------J_7'y_�_____-----L�:------ �/ �U�-_--------- p Owner's Name--------------------�-�-�=}-'--•------C� -- - --------------- _ - ----------------------------- - ------ Phone------35 ---------------------------------- Address__. - ' ._. --- 60 < ----•------------•------------•------------------------------------------------ Contractor's Name______________________ Phone- ----------- Installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of Sliving units: ❑ Number of bedrooms + Number of baths ® Lot size----------------- �---tSQ--------------------- F ` Water Supply: Public system 0 Community systems❑ Private ❑ # I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe 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 compartments--------------------------Ca Capacity- ------ ---Size--------------------•------- Liquid depth p �' - - Cesspool: Distance from nearest welL�_____________`_Distance from foundation--------------------Lining material___________-____________---_ ❑ Size: Diameter----------------- -----------------Depth--------------------------- Privy: Distance from nearest weli---' +___________ ____________________________Distance from nearest building___________________________------------- Distance to nearest lot line____--t :----__- Seepage Pit: Distance to nearest well----------------------Distance from foundation____________________Distance to nearest lot line-------------- -- ' ❑ _ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth---------------- isposal Field: Distance from nearest well------------------Distance from foundatio y�- - _Distance to nearest lot line_____ 5 Number of lines,---------___ � Length of each line_____7-Q �- _ _-Width of french_________ - -- -__-___--___--_ Type of filter material___'1____'f OL�?._Depth of filter materia r ,1.�� +t fa uR, Remodelin and/or repairing (describe):____._________ - -------'.-------op : -e ' ------. r w 11�6.-k v----- --------------------------------------------------------- hereby certify-A-5-1:1 have prepared this application and that the work will be done in accordance with San Joaquin County ordi , 5nancesand rule eand regalft ns of the San Joaquin Local Health District.lip {SignedY - . ., -------------------------- ------ - ----------------------------------------------------------------------------------- ----------•--((Owner and/ r Contractor)By:--------- --------------------------------- - --------- -----�--------- ---------------;- - - --- ----- [Title)-------'-'------- ------------------=------------------------- (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___------- - - --Sc� ------- ' REVIEWED BY -------- DATE--- -----/ � BUILDING PERMIT ISSUED--------------------------------------------------------------- --- --------------------------------------- DATE------------- --- - ------------ - Alterations and/or recommendations____________________________ ----------------------- -----------------------------------------------------------------------------------•--------------------------- ----------------------------------------------------------------------- -------•------------------------------------------------------------- ----------------••-•-------------------------------------------------------- PERMIT No.- - �'----------- ISSUED----e� - _--- A r� ______________fDate] FINAL INSPECTION BY:----L "---__--/!_----___- ------------------------ Date---------------- _T7o SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street _4-•-•2M 9-50 W-1639 Stockton, California �