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APPLICATION FOR SANITATION PERMIT <br /> Compete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> kt <br /> JOB ADDRESS AND LOCATION.-•-------72�=•_0-ark,tQn--�t------------Sto <br /> --------c------on-Calif,---- ----------------•------------------------------------------------- <br /> f Owner's Name-----Ruma ,x---K-$oits_---- 'F ', k t„---------------------------------------------------------------------------------------- Phone-------„r'------------------------- <br /> Address-------727--Carltim.-St------------------------------------------------------ <br /> Contractor's Name----------------------`----------------------- --- Phone---------------------------- - <br /> Installation will serve: Residence {# Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑-,.�, <br /> Number of living units: F11 Number of bedrooms ❑ Number of baths ❑ Lot size__:acro____md,__halt_________________________ <br /> Wafer Supply: Public system ❑ Community system ❑ Private A � <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E# Adobe it Hardpan ❑� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from'foundafion-----------------M 6fe`ri6 1­77`77-777�--- ------ <br /> ❑ No. of compartments--------------------------Capacity-----------------------Size-----------•-------•------------Liquid depth-------------------------- <br /> CDistance Distance from nearest well__-_s Distance from foundation______ r_-Lining material-_____ _______________•_______.__-_.. <br /> Size: Diameter-----4J-x K-----------------Depth-----------G------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____________________________________- <br /> ❑ Distance to nearest lot line_________________________________________.� -- <br /> '. Seepage Pit: Distance to nearest well-_51_.fa0#____Distance from foundation___,'12_1.__,Distance to nearest,lot line_--150 <br /> Number of pits....1...............Lining maferialgre flat________Size: Diameter_ .$_t ___�-------Depth__C----__.------------- <br /> .__.- <br /> Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line_______-___-_____ <br /> ❑ Number of lines-----------------------------------Length of each line-------------------------------Width of trench_.________________._______________ <br /> Type of filter material--------------------------Depth of filter material-_-______-_________:-__ <br /> Remodeling and/or repairing (describe):____Blzildixlg_ZIe�__tlr�in �__at __hath_�'o4m__ire._d�ell3n�__1�I.113i __t31__-be_ <br /> -------------4--mm--flf__a__pLip_a__line__canat__.I'o___in.-L*A.-_cat1f,_-_emd-_nava--worked for_1ax'ieh_.and_So-no--_in--this <br /> hW►i Chia i?lacB f� ho w-------------------------------------------------- ----, .. <br /> ------------ --------------------------------------------------- <br /> ---------------------------------------------- ------------------------------------------------------- ----------------------------------------------------•--------- •---------------------------------------........ <br /> I here4ceffythat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinancess, and rules and regulatioof the San Joaquin Local Health Disfrict. <br /> (Signed)---- --------------------=--/ o -------------------------------------------------------------------------(Owner a"%V voni etor) <br /> By:------------------------------------------------------------------------------------------------------------------------------------(Title)----------------------------------------------------------------- <br /> R ;(Plot plans, showing size of-lot,location--of system in relation-to-wells, buildings;--etc.j-must-be filed with-this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------- _ J0 -3 ` `-0 <br /> DATE ------- <br /> REVIEWED BY-----------------------------------• --- <br /> --- ---------------------------------------------------------------------- DATE------- ---06.. ------------------= <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------- ---------- - <br /> Alferaficns and/or recommendations------------------------------------------------- ----------------4----- ----- - --- <br /> Ze- <br /> C116 <br /> -- ---- ---- - � --- ------ -------- ----- <br /> ---------------------- �-=-_=-----•----------------------- -------------------------------- --------------------------------------------- ------------------------------------ � <br /> ------------------------------- <br /> --------------------------------------- - -- <br /> PERMIT No.---- ------------ ISSUED----- _ __�--5 - _-- (Date) FINAL INSPECTION BY:-----X-Ar �_ <br /> Date------------- - - F/ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street '^ <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 s <br />