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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. rJ06 AD IV W tc_�-c -,�{ i D 8'l-- 11Lf7 -03 DRESS AND LOCATION-`--J-�-,-,j-2rj rth_1�11lf------ �'-- ¢Q------/3 ' Owner's Name _JIB rCt/1v �A�' -----f 1-_/4.S -------------------------------- Phone----1 Address------------------r ---------------- Contractor's Name------Mewtv ------------PNur �/(/ Phone -------------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other jo S'4 ego Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size______________________________________________________________ Water Supply: Public system ❑ Community system ❑ Private ; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam V[ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---0-0......Distance from Material-----C�,O.I✓Cl`P4121_-_-_____-_ No. of compartments-----------+ __6a &-�___ .Capacity_ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material___________________________________! ❑ Size: Diameter--------------------------------------Dept h-_------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line_______________________________________________ `~ 'Seepage Pit: Distance to nearest well-_____________________Distance from foundation--------------------Distance to nearest lot line---------------- ❑ Number of pits----------------------Lining material----------------------.Size: Diameter----------------------Depth------------------._-----------. : ij ,Disposal Field: Distance from nearest well___1412'____Distance from foundation----2.dQ`_._.Distance to nearest lot line...... {� Number of lines____________ ______ ___________Length of each line----------- 0__ /_____.Width offrench----- ___a�C_______________;_ Type of filter material___-llG__�_______Depth of filter material______AL�--_-__--- t ` `Remodeling and/or repairing (describe):________ _l<tl_#_A11T�r�'_`1,A-�',f,��______.,ev� 1________4�_t_$_�`? _j_ __� _o__ _______- . ----------•--------------------------------•----------------------•--------------------------------------------------------------------------------------------------- k ----------------------------------------------------------------------------------------------------------------------------------•---- ------------------------•----------------------------------------------------- ------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------••---------------- 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. > lJ /!OIF /i1/� ------ ��T/�, (Signed) '03 (Owner and/or Contractor) BY: (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--------------&-8--- r S REVIEWED BY-------------------------------------------------- - ----------------------------------------------------------- DATE------------- -i------; --- ------------------------ - - BUILDING PERMIT ISSUED------------------------------------------------------------- --------------------------------------- DATE -- t Alterations and/or recommendations-------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------- ------------------- - - - ---------------------------------------------------------------------------------PERMIT No_��_ _---- ISSUED____-- ___rC __,5"` ---------{Date) FINAL INSPECTION BY::--,-------kI---(/__"-----�--------------------------- Date------------- — - � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--•9-2M 9-50 W-1639 ,