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...,�. : � APPLICATION FOR SANITATION PERMIT [Complete in Duplicate) "6 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. 0) 7 _ 0 3 C / �Co JOB ADDRESS AND LOCATION.------C--- -------------- W"q �� Co0/��= 1 5 CG r r ------ Owner's Name--- !�__ 1//7r�/`,1/ r------------CoW.C`/^/�'------------------------------------------------------------- Phone----- --------------- Address ------.../?o_C!� --- --------� ---------------------------------------------KFS -C� � - d--------------------------------------------------------------------- y Contractor's Name---------------------------------------••------- --------==-------- ---------------------------------------------------- Phone----------------------------------- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ElC Other Number of living units: ❑ Number of bedrooms E] Number of baths E] Lot size--------Ix-E-0--------------------------- Water Supply: Public system E] Community system E] Private 1 Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑n Clay Loam ❑ Clay ❑ Adobe❑ Hardpan + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r i Septic Tank: Distance from nearest well--__�a -------Distance from foundation-_---�Q_--------Material-_-_--C Oly Cr 4'`.7'E_-____-_- © No. of compartments------tW_9--------Capacity---g±2-a----------Size- /fY 9-f--x -----Liquid depth---,_---- -�---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------- F1Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------- ---_%111110, ❑ Distance to nearest lot line------------------------------------------------ �I Seepage Pit: Distance to nearest well-_-------------------Distance from foundation--------------------Distance to nearest lot line---------------- { N Number of.pits----------------------Lining material-----------------------Size: Diameter----------------.------.Depth-------------------------- ,Disposal Field: Distance from nearest well------(-pJ'�Distance from foundation____�a_ 4/&___Distance to nearest lot line_ fe_- L.�..} s ♦ -----------lines----- ♦ ----- Width of trench--------------- - - -- Type of filter material-__ �''_ 4_�epth of�filter material----------------------- Remodeling and/or repairing (describe):-------------/Yr!.4/__-_-----___/5"_-0,4,1- --------------------- ----------------------------------- -- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify +hat I have prepared +his 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. (Si ned 't.c ,, r' 9 ) --.: - !.C.r.r 1-j-' (Owner and/or Con+racto By:-------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------I (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with +his application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - =------ DATE-----=-r -71 BUILDING PERMIT ISSUED---------------------�------------------------------- --------------------------------�-•------- DATE--------------�,•�-��-.S�j------------------------ REVIEWED BY =---- DATE-------------------- Alterations and/or recom enda+ions:--------I--------------------------------------------- - c.. Q-®f��-y-c. �- 3 X X , - r✓7d_ y � F-�C rrv_ T.,t` - = ------------- ---------- - --- o --- g"' --�---------- ------ = F �2a�. -e - °- - --- - - � �---- '�'- -------------- G�.-------��✓�....------------------------------ "------ ------ ''r--- ---------------------,�G --- ---- �_ �-- PERMIT No.__a..�,�--------- ISSUED--- ------------(Date) FINAL INSPECTION BY------------------------------------------=-------------------- Date----------------------------------------------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT ; 130 South American Street Stockton, California _ ES-9-2M 9-50 W=1639 $,.� `