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j - 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-------P-t-.---29----BCLX---487---Aaarupo------------------------- Owner's Name---------F-rAtZ---Edaori ---------------------------------------------------------------- --------------- ------------------------------- ------------- ---- Phone-_97-9321------------- . on,tractor's Name-------------��I�a--- -------- ---------------- -- --- ------------------------------------------------------ __ _____________________________ ------------------ ------- ---------------- ------- -- --------- -- ------ Phone 3_-5955---- Installation will serve: Residence ©; Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [j Number of bedrooms 0 Number of baths ❑1. Lot size----- --- Water Su pp Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ HardpaoE] 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_____5(t_--_-_Distance from`founda'tion________ t _ �X IS'1 lG .-T----Material'! -= J �► No. of compartments--------T---------------Ca aci T --------------Size-------------------------------- P tYLiquid depth----- ------------------- Cesspo 1: Distance from nearest well-----------------Distance from foundation___________________Lining material___________._________-- Size: Diameter----------------------- ________ r ---- - - ------- Depth-- •------- ---- --- - -- - --------------------- rivy: Distance from nearest well________________________________ - Distance from nearest buildin i Distance to nearest lot line _ g ----------- Seepage Pit: Distance to nearest well___41qPW.VDistance from foundation_____-_------------ r ______.Distance to nearest lot line______-_____:: `- Number of pits------- ------------Lining material__}-_1_Qlk------Size: Diameter_---4f--------------Depth-----25.-----_-_..___ ---, Disposal Field: .Distance from•nearest well=____"_ -Distance from foundation__-_�_-_ __-Qisfiance fo aresf lot line__ ___ _____ TO �71i7 PUT IN Number of lines-----------------------------------Length of each line--------------------------- BY OYNER Type of filter material-------------------------Depth of filter material------ Width of french-----------__--________-- --------- - r I Remodeling and/or repairing {describe):______-_-Ins_t_�,]]_ fir n0Q� � ,ain r sa?�d_.-_3f._ a1Q eco_: �S_an_-J �zn-_ _ I ._�er� ._ ----------- ------- ...� - - ---,�------- -- ----- --- -------------------------------------------------------------------------------------- = - ---------------------'--- - 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) h ------------------------ -- ---------------------------------------------------------------(Owner and/or Contractor) By:-------------------IPerr --: arthan - -----(Title)--- Or er-1Tr (Piot plans, showing size of lot, location of system in relation f'8—W K buildings, etc., must be fled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -__--__ ---------- i - --REVIEWED BY ------------------------------------------------------------- DATE__ r ----- DATE BUILDING PERMIT ISSUED--------- ---Z _---_ ----------------------- --------------------------------------- ---- -------------- DATE ------------------------------ -- Alterations and/or recommendations:__=____-_________ - - - -- ----------------------------------------------------------------------------------------------------------------------------------------- `PERMIT No.__.!___-L__--- ISSUED------- --3 ---- ----- ---------(Date) FINAL INSPECTION BY:------------- Date- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W4639 Stockton, California