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?017 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. (Z3 -- 6-7b —p JOB ADDRESS AND LOCATION------------------------------- _ � '10 Z -4 ___________ 9 -Owner's Namei—ef4146/C.F Itvo / �/_D,<x'0 G` -------------------------------------------------------- ------------------- _ ----------------- Phone Address----------------------------------------- ------------------------------ , ` Contractor's Name--------------------------- /=/_ G_---/DefAj t#- f',---•--------------------------------------------------- Phone---------------------------------- Installation will serve: Residence [�( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: U6 Number of bedrooms i§ Number of baths t Lot size______- _____________________i Water Supply: Public system [Community system ❑ Private L❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam e Clay ❑ Adobe Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well_________________Distance from fojerrdation--------------------Material____ �-___'d ---C'.0 I r [� No. of compartments------�-'--------------Capacity-5>1x�ze---------- - ----------- --Liquid depth-----�'--------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______________________________ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------. Ah_ 'Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line________________________________________________ i—jrt Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ;W ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------____-- O ,_Disposal Field: Distance from nearest well------------------Distance from foundation_____1'�0______r_Distance to nearest lot lin ___ / j Number of lines___.____._` ______._ Length of each line--- _ -- ____ �g:___-Width of trench_-____ _�__________________ Type of filter material______________ __��bepth of filter material----____.'` _ --._._ Remodeling and/or repairingdescribe):________________________ - -------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------•---•---------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I ha repared this application and that the work will be done in accordance with San Joaquin County ordinane aws, a las d regulations of the San oaquin Local Health District. {Signed) -- - •------ ------ -- --- - -------------- ---------------------------------------------------------------(fir and/or Contractor) By:-------------------------------------------- -----------------------------------------------------------------------------------__(Title)---------------------------------------------------------------- (Plot (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 REVIEWED BY---------------------- � --- ----------------------------- DATE----------------- BUILDING ---------------BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations---------------------------------------------------------------------------------------------------- -----------------------------------•------------------------ --------••-----•----------------------------------------------------------.._-._...------------------------------------------------------------------------------------------- ---------------------------------- ----- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------ ------------------------------------------------------------------------------------------------------•----•---------------------------------------------•-----------------------------------�-------------------------------- PERMIT No.40VI----------- ISSUED-------ll'34-�� ---.--(Date) FINAL INSPECTION BY:---- ------ vdl_ _f<<a'1-------------------------- Date----�2 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W-1639