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r. 1K, APPLICATION FOR SANITATION PERMIT . (Complete in Duplicate) 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 _ '--"- -----/------------�....--- --------------- ---_ ----------- Jt ��-lr t-A ------------------------------- Phone------------------------------------ Owner's Name----------------- ------- ------- --- ---- : �------------- ---------- ----- Address--------------------- -----------� 6-vnt----------------------------------------------------------------------------------------------------------------- Contractor's Name- ------- _ er--------- --------------------- - ------------------------------------------ Phone----------------------------------- ------------------- ----- - ------i------ 1_W Installation will serve: Residence Apartment House E] Commercia4 ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I Number of bedrooms Number of baths I Lot size---------117 �-�"�------------------ Water Supply: Public system ❑ Community system ❑ Private V Loam Clay Loam Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy ❑ y ❑ 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-------------------------_-� J '-Cesspool: Distance from nearest well________________Distance,from foundation-------------------- materia4__--- _____________-_____________ , t ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------- Privy: ------------------ ------------------------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________.____----___________-----_____. ❑ Distance to nearest lot line------------------------------------------------ 1-11" - Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______-----______ ❑ Number of pits----------------------Linin material-----------------------Size: Diameter------------------------Depth_----------------- --- --- Disposal Field: Distance from nearest we)--30 ___.Distance from foundation�I-________.Distance to nearest lot ine___ Q.__ Number of lines_______________ ___________ ____Length of each line--------LL-D---------------Width of trench----�-----____-----_------- Type of filter material_11 �KsC ----Depth of filter material_-___t_$_1j-____---- F Remodeling and/or repairing (describe)___________ ______ __ _____________ -- ------ _ --� � ___ _:::____ _ --_---------------------------------------- ---------------- --- Yt ---- ------------------------------------------------------------------------------------ --- j I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, teelaws,4and rules and regulations of the San Joaquin Local Health District. (Signed ----- ------- ---- --------- ------ ------------------------------ ------------------------------------------------------(Owner and/or Contractor) - ---- ------------- - 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 -----�-- ----- ------------------ - REVIE /E: BY ---- ------ DATE-------------- --------- ---------------------------------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------- ----------------- DATE_ Alterations and/or recommendations---------------------- -------------------------------------------- --•--------------------------------------------- ------------------------------------ ---------------------------------------- ;.� . --------------------------------------------------- ,- ,. PERMIT No-7a-1--------- ISSUED 5 ----------(Date) FINAL INSPECTION BY:--- ---------64*"_V GlA-a,�� Date------------------------------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California /2M 9-50 W-1639 „�