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APPLICATION FOR SANITATION ON PERMfT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desc ' This application is made in compliance with County Ordinance No. 549, abed. 4 I JOB ADDRESS AND LOCATION----------- Owner's ________-IOwner s Name-------------------------=-------------- --TgnaOtL ----------------------- --------- Phone �S}----------------- ------------------�.--------------------- Contractor's Name-----------------=-------- =--A,__FARR1M_:&_SOBTS I iC r- --------•---------------------------------- Phone-------%•9607----------- Installation will serve: Reside n:ce Apartmenf House ❑ 'Commercial, .❑ Trailer Court ❑ Motel ❑ Other Number of livingunits ❑ II Number of bedrooms [2 Number of ba+hs M Lot size______501t I 1t'__ Water Supply: Public s stem] ""---- _---------------` PP Y= y I❑ Community system ❑ Private [ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Lr �i. Yoam ❑ Clay ❑ Adobe [� Hardpan ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Se tic Tank: II Q- P Distance from nearest well_____--_----Distance from foundation-------,21------Ma+eriaf_______{,_ +� No. of compartments 2--------------Capacity--- �r-------Size�6 6 -----Liquid depth------52�32�------------ ,Cesspool: Distance from nearest well________________Distance from foundation________ Lining material------------------------------------- ❑ Size: biameter--- ------------------------ :� - -----Depth--------- -------- ------------------------------- -Privy: Distance fFom nearest well______________ ___ _____________Distance from nearest building___-________----_--_-----: ❑ Distance foPnearest lot line-----------------tT____ Seepage ----------- Pit: Distance to�nearest well____1�j-__ Distance from foundation -_'1_'21---------Distance to nearest Number of-,pits---- , its--- I �__w� P w x� �P Lining ma+erial � G ET6 ¢e'._Diameter Depth - - 201 .. D r --- m nearest well____ _f-----Distance from foundation______�Zr__----Distance to nearest lot line------5r � Number of lines-----�--------- -- - - -------Length of each line_------5©�-----_-------- � � is osa Fie d: Distance fro T e of filta Width of trench____________21t_____-__ Type r materia!____Z __� pepth of filter material____- ��',"___-""__ Ij ng and/or repairing (describe):---------------- _ L18 $ I� O�----- I -------------------- ---------------------------------------------------------------------- ----------------------------------------------------- hereby •-- ___1--------- --------------------------------------------------------------------------------------------------------------------------- ordinances, State lcertify sthat Ihave" rules prepared this application and that the work will be done in accordance with San Joaquin Count s and regulations of the San Joaquin Local Healfh District. y ij (SignA T�- ---------a-----------------a--- ------ ----�'- -----• - By ./fS+ + ( Contractor). {Plotf tot, l0 itle------ i�cation of system in r tion to wells, buildings, etc., must be filed with this plication). Ii FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ _._. _" 1 ------ B — ----------- - DATE REVIEWED BY - ---- - 4% DATE • -- ,---BUILDING PERMIT ISSUED__ Il � ;;--------------------- � DATE --------------- A aerations and/or recommendations:_________-" ----------------------"_-____ 1 ----------------- ------- ---------------------- -- --------------------------------------------------------- - ------------------------------------------------------ ----------- ------------------- ---------------- ------------- i --- -------- ----------------- ----------------- ------------- - ----------- fl A l4 '--------------- ------ _ ID------------------------------------------S PERMIT No __ I -- -----""""-- (Date) FINAL INSPECTION 8Y:_ -------------------------------------------- IM Date ---------- - �� SAN JOAQUIN LOCAL HEALTH DISTRICT II 130 South American Street- Stockton, California ES-9-2M 9-50 W-1639 .I