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APPLICATION FOR SANITATION PERMIT f � { (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. j . JOB ADDRESS AND LOCATION__._ _Q _Q__E_t___ g ---` ..... 1-0-0-t0 � a 1-3. Qx 1 .+ ----------------------------- Phone------------------------------------ Owner's Name-----------------�-�;-�'-_�_-.&--Mrd_•-__��_�r1__-'�-_-"-_._S�fx'_�� ---------- -------------------------------------------- Address------------- s'eet_raJ"D_cktol�r----Calif_orni.a.--------------------------=-----------•------------------------------- Contractor's Name D 1 a--aeLgt-Le---Tank__Z_erv1!ae-------------------------------------------------- Phone_'}" ��5 Installation will serve: Residence [A. Apartment House 1-1 Commercial E] Trailer Court El Motel El Other El Number of living units: ❑ Number of bedrooms ?] Number of baths [� Lot size---------60_x__l60_-_±________________________ Water Supply: Public system ® Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Gay Loam ❑ Clay ❑ Adobe [3 Hardpan ❑ 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------------------Distance from foundation--------------------Materia..----------------------------------------------- ❑ ex8i3t i 'N& p --Size------•----------~-=_-----Liquid depth------------------- of compartments Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining maferial-------------------------------------- ElSize: Diameter---------------------------------- --Depth----------------------------------------------------- Privy- ------------------- -----------------------------Privy: Distance from nearest well---------------------------------------- -----------------------------------jin _____..Distance from nearest building ❑ Distance to nearest lot line------------------------------------------------ ___.Distance to nearest lot line_____ ___Seepage Pit: Distance to nearest well______________________Distance from foundation______1 __ tNumber of pits_____1______________Lining material_-_bri•Ck-___-Size: Diameter___._____ t- p 29 Disposal Field: Distance from nearest well______-________Distance from foundation_______________-___Distance to nearest lot line_________Number of lines____-_______�____________________Length of each line--________5q__�`__t_�,._Width of trench_____ Type of filter material-----PggX--------Depth of filter material----18__--in--___ z Remodeling and/or repairing (describe):---------------------------------------repair-Ing----------------------------------------------------------------------------------------- ------------------------------------------------------- -------------------------------------------------------- ' ---------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 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 an Joaquin Local Health District. I3e3.t8 Pt i.c T ervin (Owner and/or Contractor) �( g ) ..... Owner—Mgr BY:------ -- ------------------------------------------------(Title)----------------------------------------- ------------------- ---- ---------------- -- -- ------ - - (Plot plans, showing size of lot oc tion of sys em in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- __ DATE----------------------------------------------------------- REVIEWEDBY-------------------------------------------------------- _----- ---------------------------------- ----------- DATE-------, 5... ------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------- --------------- DATE----------------------------------------------------------- Alterations and/or recommendations---------------------------- ---------------------•-------------------- ---------------------------------------------------- I ---------------------------------------------------------------------------- -------=------------------------ -- - PERMIT No._&K------------ ISSUED_l `1 =5 -----------------(Date) FINAL INSPECTION BY:------ ----------------------------- Date----------------- ----------------------------Date----------------- '''` ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street } Stockton, California ES-9---2M 9-50 W=1639