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� ^7 ' APPLICATION FOR SANITATION PERMIT -7 (Complete in Duplicate) J :�j 0 14 z 7's 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--- _.------- ------400-1 - Owner's Name--------------- A-4-1[� *_e_j Phone Address 1 "' 3 - *d �-�° - Contractor's Name--------------------6 -elr -"-------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence P? Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _ Number of living units: ❑ Number of bedrooms Q Number of baths IV Lot size__________ � � - Water Supply: Public system ❑ Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam"' Clay ❑ Adobe 0 Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if,-publics ewer is available within 200 feet.) Septic Tank: Distance from nearest well_____�'_________Distance from ® _ f undation_______Nu__ Material------�e,_8Pjv- --------------- 10 ____ ________No. of compartments Capacity ---Size____34_4_ _ '_ Liquid depth __ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______________________-___-__:_-_ ❑ Size: Diameter-------------------------------------Depth------------------------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 0 Distance to nearest lot line------------------------------------------------ E Seepage Pit: Distance to nearest well----------------------Distance from foundation____:_____________-Distance'to nearest lot line_______________ ` ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------------------Depth--------------------------------_ .Disposal Field: Distance from nearest well___,4_u-------Distance from foundation--10- _-_-Distance to nearest lot line---, ___- Number of lines_________ _________________ ____ ength of each line__=: 1- �'-- �-__--Width of trench------�c4Y------- • � it Type of filter mat ial�fl_' ___ _ epth of filter material___ __"_ _- ------ Remodeling and/or repairing (describe)- ��-- = ........ ---------------------- ----- ------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------= ------------------------------------------------------*-------------- 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 S.jpn Joaquin Local Health District. (Signed]._-�1 `"'°` ( / ) A Owner and/or Contractor B • � ____{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------ r" !" REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------------- DATE �-' BUILDING PERMIT ISSUED--------------------------------------- U-- --------=----- DATE Alterations and/or recommendations_ L !, e�--—--------------= -------- �-�Er¢,1 :'Z,1�-~-----~ = yq. -----------------=----------------------------------------------- --- - ----------- _ PERMIT No !_ _(.,Z____ ISSUED____ _____; __-41 J7________(Date) FINAL INSPECTION BY:________ _ � ----------------------------- bate-------- --___________________©ate-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street Stockton, California r ES----9-2M 9-50 W-1639