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, 'M I L#7 = I APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 's Application is hereby made o the San Joaquin Local Health District.for a permit to construct and install the work herein described. This application is made in c mpliance with County Ordinance`No._549. �• } sir � - JOB ADDRESS AND LOCATION------------------ 4+58-C emo—Xee--_La �_-----------------------------------------------•--------------------------------------- } Phone-----6-rr-63-8-1------- , OwnersName.-----------Rar red---Fr-3.eilir------------------------------------- - --- --- ------- ------------ -- Address... 23- ' CcQL>Ar Ce_�u?._.? lYd • Contractor's Name-------�}e �ht3--------------------------------------------------------- -------------------- --- --------- -------------------- Phone _3_x_3955---------- Installation will serve. Residence FE] Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ �I Number of living unis: -� Number of bedrooms [l Number of baths ❑1, Lot size__________�_Q�____�___1�]Q�----------------------- Water Supply: Public system ❑ Community system ❑ Private ] Character of soil to a dept Illof 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam LlClay F1Adobe a Hardpan TYPE OF INSTALLATION IND SPECIFICATIONS: k (No septic tank or A1sspool permitted if public sewer is available within 200 feet.) I,�&kIstIn' No- of p --1 Capacity ! ------------Liquid dep rit--------------------- om artments------�-------- -------Ca acit ----�OQ---- ---Size----------- ----- th----•--------------------- Septic Tank: Distance from nearest well__54_________Distance from foundation_____ _ _ ------- __-______�G]Ti 1111 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------_------------------------------ r ❑ Size: Dimeter--------------------------------------Depth---------------------------------------------------- Privy: Distancepl from nearest well-------------------------------------------------Distance from nearest building-----------_______________-_--_-________- i _ Distand to nearest lot line-_-------------------------------------------- ❑ ---_Distance from foundation__________________ Distance to nearest lot line.•_-________---_. Seepage Pit: Distance to nearest we{{_________________ ❑ Number of pits_______;_________ Lining material______________________ p 111 Disposal Field: Distance from nearest well__40---------Distance from foundation to nearest_ Size: Diameter_________________ _.Det __ I t r t lot line_____--------- ] Numbeof lines--------1------------------------Length of each line-------/0 d----i-----------Width of trench----x.___221---------- Type of filter material_z'_O.4k------------Depth of filter material------- Remodeling and/or.repairi�g (describe)-------------rep3-Ir-In ,---c3rain------------------------------------------------------------- --------------------- ----- ---------( ------------------------------------------ ' . ------------------------------------ -----------------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 District. (Signed) D_e3., � 5-ept_lo----T_axik_:_lex --------- X----------------------------------(Owner and/or Contractor) € sY= = '� 'X'�C - a r -Y az a -----(Tale)------Qwn.erTrMgr!--------------------------- (Plot plans, showing size oft, location of system i relation4to ell , buildings, etc., must be filed with this application}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- ---- -_ ---------------------------------- DATE------- ;f IIS / REVIEWEDBY--------------------II�------------------------------- - - DATE ---•-- -�l ------------------- --------------------------------- Alterations ----------------------------- AlterDat ons and/or ING Trecomm�endations--- -- --------------- ------------------------------- --------------------------- DATE---------- - ----------------------------------------- ---------------------------------------------------------------------------------------------------- ' ..-------------------------- ----- ---------------------------------------------- -------------------------- ----------------- -----•----------------��I IIS - -------------------------------- ------------------------------------------------------------- ----- -------------------------- ------------ ------. �h---------------------------------------------------------------... --------------------- --------------------------------------------------i-------------------------------- V -----------------------------------------------:---•----------------------------- 1 I I55I1ED____ ___ __s Date FINAL INSPECTION BY:---------No.. i '� RI Date------------------- -----`---6---------- ----------- ------------------ P, I SAN JOAQUIN LOCAL HEALTH DISTRICT V 130 South American Street Stockton, California E5-9-21A 9-50 W-1639 ',