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kssff' fi —�- APPLICATION FOR SANITATION PERMIT F 0 (Complete in Duplicate) i !Application is hereby made to the San Joaquin Local Health District far 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-----------------�__7_�--Td� -- -�- ----------- ----------- ---------- -------- -----------------------------------------------------------' Phone_:,-_-- D --- SlY ______________ _____ Owner's Name------��X'-�-'---�o-ra.---- 1�. a�I1S----------------------------- Address ,--------- ------- -r Address----------�`��--��-�----��'---��-��-----------------------=----- - -:-----•-_ �-395 - Phone--------------------------------- Contractor's Name Delta----------------------------- ------------------------- ---------------------------- g_' ' a In f ' e © Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other stallation will-serve: Resident _ F +.:• Number of living units:r] Number of bedrooms [ Number of baths [� Lot size___ -O �.QQ___________________________ ------------- =q Water Supply:. Public system f] Community system ElPrivate E-1 't Character-of soil to a depth of 3 feet: Sand E] Gravel F1Sandy Loam ❑ C1ay Loam ❑ Clay ❑ Adobe Hardpan E] TYPE OF,,INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` r Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- LA No. of compartments--------- ----------------Capacity-----------------------Size------------------- Liquid depth = - = XZS©Ii�13G a. - ---------- Cesspool: Distance from nearest well----------------- from foundation____________________Lining----------------- material Size: Diameter--------------------------------------Depth---------------------------------------------------- ----- ----- ------Depth--------------------------------------------------- 4r' privy. . •Distance from nearest well------------------------------------------------- from nearest building-_--------------------------------- _____________------:--------------- -Distance to nearest lot line------------------------------------------------ `* � '."Distance to nearest well _'l>E_____ -___ Distance from foundation___=_____-_._ Distance to nearest lot line __ Seepage Pit: f 20-1 , { ,n P%Number of pits--------I-----------Lining material brIcY_----- Size Diameter_��1r1 Depth_-. ----- CN -_ ,....Disposal .Fie4d:z- Distance from nearest well------------------Distance-from foundaiiori Distance to nearest of me______.._ " --------------Length of each line------------------------------Width of•trench_..--_--------------- � DII•�G . Number of lines ry i �Type of filter material________________________Depth of filter material_________________.___ Remodeling and/or repairing(describe):--------Inst-a,.11l"PZt__ns: ak3_.rl u �?=�---�-o_la_d_-� ane._ ------------- ----------------------------- --------- -------------------- -_ ________________________ r - S i i ---- ----------------------}----------------'--------------------------------------------------------------- - --------------------- - I hereby certify,that I have prepared..this application and that the work will be done.in accordance with San Joaquin County ordinances, Stafe`jaws, and rules and regulations of the San Joaquin Local Health District. Si ned " D;r1t_r1-- (Owner and/or Contractor) ------------ ( '9 )-- ----- Owne t I Perry 1 a_r_tl�anXa flh ------------------------------------(Title---------------- X---�r--------------- ----------------- } (plot plans, showing size of lot, Iota#ion of•system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY Y - DATE----------- -------------------- —`_--- _ APPLICATION ACCEPTED BY---------- ----------------------------------------- TE ,. REVIEWED B PERMIT ISSUED--------------------------------------------------- '�--------- DATE-------------- BUILDING --------------------------------------- Alterations and/or recommendations--------------------- ------- --------------------------------------------------------------- ---------------------------------------------------------------------------------------- ------------------------ ---------- - ------ ---- --- -------------------------------- y[ ;s PERMIT No. - ._ ISSUED--- --- 1 -- ---(Date) FINAL INSPECTION BY: ------- • Date_ --- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ib } ES-9-2M 9-50 W-1639