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APPLICATION FOR SANITATION PERMIT v [Complete'in Duplicate] Application is hereby made to the San Joaquin Locai 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---------' � t x'di13a1__, --5 !t t-------------------------------------------------------------------------------- Owner s Name-------------------------------------------------- -------------------------- Phone-----4-9345--------------- ' Address -------- ---------------------------------- -- f'&Tdla1t '$� e------------------------------------------------------- -------- -------Ar__�9L.__�'W-TM-&_MXSr--33r- ---------------.-------------1----------- Phone----��--------------- Contractor's Name___________________________ of ])qg Installation will serve: Residence Mr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Mand m & et. sink Number of living units: E! . Number of.-becl:ooms [2 .Number of baths La s�ze__________________T fiX1951------------------------- Water Supply: Public system ❑ Community system ❑ Private ► " Character of soil to a depth of 3 feet: Sand E] Gravel Fl,.,Sandy Loam F1 Clay Loam ❑ Clay ❑ Adobe [$Hardpan ❑ V� - W � TYPE OF INSTALLATION AND SPECIFICATIONS: Sa (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Septic Tank: Distance from nearest well----Distance from foundation__-------Material----- ; irti.ng No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining mat erial____________________________________. .❑ Size: Diameter--------------------------------------Depth------------------------------------------------------- Privy: -------------------- ------------------------ ----Privy: Distance from nearest well-------------------__________u______-_________-_Distance from nearest 'building------------------------------------------ ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well__1001- .________Distance from foundation____ --------Distance to nearest lot line---P_________ Number of pits______-I._ ______ Lining material_'__ --Size: Diameter----_33 ------ _Depth____----W--251------- " ` Disposal'Fie1c1' � Dista''nce=fpm-rsearet well= `D(stance'from'foundativn= -`=-Dista�ice to-neaFes -Ica} F&sting Number of lines----------------------------------`Length of'each line------------------------------Width of french------------------------------------ Type of filter material-------------------------Depth of filter material_______________________ 7 ---------------------------------------------------------- Remodeling and/or repairing {describe �� _-�T-SB ------------------------------------------------------------------------------------------------------------ --------- - -- ---------------------------------------------------------------------------------------------=---------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health .D.istrict. (Signed) *_A• S ANG.. .. + • Contractor] ------ ---------------=--------------- --- ------------------------------------------ By:---- ---;--------- [ -- -- ---------------- ---------------- -------(Title]-----Tstim&tor------------------------------------ [Plot plans, s ing size of lot, location of system i relatio)to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------r---------------------------------------- DATE __ REVIEWED BY--------------------- ------ -----------=---------------------------------- -------------------- DATE - ---------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ DATE " . � . Alterations and/or recommendations-------------------------------------- - --- --------------------'-----------�7s'-----` {--------------------------- ,0 ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- -------------------------------------- - - - - --------------------------- - -------------- =--�_ ISSUED-- �f��_--r/---�--- --[Dat--- --- ------------ ---------- - PERMIT No.---- � el FINAL INSPECTION BY:-----------/-------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California r ES-9-2M 9-50 W-i639