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' APPLICATION FOR SANITATION PERMIT r kk (Complete in Duplicate) Application is hereby made io the San Joaquin Local Health District for a per-mit to construct and install the work herein.described. This application is made in cdmpliance with County Ordinance-No. 549. " 4 JOB ADDRESS AND LOCATION______________ L ------------------------ wner's Name-------------R,--T''��•-__-- o _n&om----------------------- V,- Address_ .gooPhone-- 3n7112 6 -- ------------------------------------------------------------------------------ ------- -------------------- -Contractor's Name-----------------I D� 's3------------- Phonej-95-r5--•- ;s. Installation will serve: Residence ® Apartment House E] Commercial ❑i Trailer Court E] El-' Motel Other E]Number of living units: [ Number of bedrooms 1� [2. Number of-baths Lot size______-__ 011 ------------- Wafer SuPPY� Public s 1 Pblistem y Community system ❑ Private ❑ Character of soil to a depth e�f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ -Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ �i' t, `�3 �.. t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or ces pool permitted if public sewer is available within 200 feet.) ! Septic Tank: Distance glom nearest well___-__-�---------Distance from foundation---------±-___-__-Material______'�r--ic-1p_ceLgp-,1t ~ El No. of co'partments--- -P------------Capacity_ t - t - 0Q Size -4.---5:-----------Liquid depth__4'_ec �- I Cesspool: Distance Thom nearest well-----------------Distance from foundation-------------"__-_.Lining material____-_---__.___�_ -____. ___ - r ❑ Size: Diam�eter--------------------------------------Depth---- ----------------------------, Privy: Distance frl�om nearest well________________________-_ _ i_______________Distance from nearest building___-__.-___-__-.___-____ Distance to nearest lot line _ :___-_______ Seepage Pit: Distance to nearest well_-_-___{______________Distance from foundation___Z© _--___ t C Distance to nearest lot line-------- ® Number of pits--------I-----__----Lining maferial__10r-i lak-----Size: Diameter--__ =-Q.d:_.Depth_'_� _____________ l.Dis osal:.Field: .._ D.istanee.from nearest well_____-^____-_ / p — W _. ._ __.Distance from foundation____le_ _____.Distance to nearest lot'iino �_0 r ❑ Number of lines--------------- ----------- Len tFi of each line`s-- ----1 --- -- �a a g = _"1/Vid'tf�of treneh_ y---__- __r__-__—__—_________ Type of filter material.�1l•'. ,-t� _�S.D'epth of filter material-------__�____--__ u Remodeling and/or repairing { escribei_-----------____z,%�II_ - rise 1 a� _2 c 11---cemera.�--r�_�cY e plc__ivu k__ d---o le_----�1� --f a_.�,. ve��ad-i------ -- - --_--- •- -- ------ A 6A L __6-A)fi14--- --- -------------------------------------- ---- - -------------------- ----- - ------------------------------------ I hereby certify that I have prepared this application and tha+ 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)-------------1)a; --------------------------- 1U ------- (Owner and/or Contractor) r By:---------peur2`- s1 _ ��.,.73- .. (Title) -r, ii (Plot plans, showing size of lot, Icatian of s stem in relation itle----Q�7��.. . ' -------------------------------- 0 1 Y to wells, buildings, etc., must be filed with this application). i ISI FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYII REVIEWED BY _I� --------------------------------------------. DATE--------- � ----- - --------------------------- -- DATE--- a -------- ---------------------------- BUILDING PERMIT ISSUED----- --=-------- -------- ---------- --------- ------------- qr - ----------------------- DATE---------------------- Alterations and/or recommendations:_____-___ ------------------------------------------------------------------------------------------------------------------------------------------------ - - ---- -------------- --------------------- ------------------------------------------ -------- • - -------------------------------------- -------------------------------- --------- --------- -III!------- ------------------------------------ - -- --------- ----------------------------- - ------ -------- ---- - �. ---------------------- ----------- ---- ---------- ----------- --------- - --fes PERMIT No.-- -l-------- ISSUI_D------ Y ------- -�--�-__--(Date) FINAL'tiINSPECTION BY------------ --- - - -- -- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES--9-2M 9-SO W=l639 I . Stockton, California