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3 a� 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. JOBADDRESS AND LOCATION------------421--W-o----at'h-- t_At-------------------------------------------------------------------------------- --------------- Owner's Name---------- jJurge=--- _eSxaQYL-------------------------------------------------------------------------------------------- Phone---3-`9-68--------==------ Address---._----- --------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name__.D2.31a-------------------------------------------------------------------------------------------------------------------------- Phone------ .r 955---------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Q Number of bedrooms E2 Number of baths [I Lot size___4-5__X._110------------------------------------ �, Water Supply: Public system KI Community system ❑ Private ❑ N Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® 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__ ��_--------Materijl____aem nt___hri�_k_________ No. of compartments---------2--------------Capacity-----$OII---------Size__�I�'-----k._ '� Liquid depth------�----:-------____-. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-____-_____--_______________--_____ ❑ Size: Diameter-------------------------------------Depth---------------------------------------------------- ! Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________________________________-_______- ❑ Distance to nearest lot line________________________________________________ 1 Seepage Pit: Distance to nearest well-------_--` -----Distance from foundation________.-_-___.Distance to nearest lot line-__-_S____. i IN Number of pits-----------1__------Lining material.._.}.rA-Ck__---Size: Diameter- ---- -�----.Depth---------.�-Q--------------- Disposal —----------- i Disposal Field: Distance from nearest well______ ---------Distance from foundation_-_-_-�-.-.---Distance to nearest lot line----- ® Number of lines---------------- -----------------Length of each line_______-10---ft-------Width of french------22T'_______----_--------__ Type of filter material___-_- rD__Ck--------Depth of filter material_--la............. Remodeling and/or repairing (describe)-----------------new---iriSt_aUat-;43xt---------- ---------------- --------------------------------- :-------------------- ----------------------------- -------------------------------------•--------------------------------------------------------------------------------------------------------------------•----------------------------------- - E ' _____________________________________________________________________________________________________________________________________________________________________________________________________________________________ 1� ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- _ I hereby certify that I 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 San Joaquin Lo I Health District. I - i (Signed)-----------D-0-lt..a---Sept•iz---Tan W., • ------------ .•-- --------------------------------------------(Owner and/or Contractor) By:---------1'_Prr_y----`far --- ---- ----- ---- --C------------------ ---------------(Title)----owner-Mgr------------ - ------ -- (Plot plans, showing size of lot, location of system. r ation to wells, buildings, etc., must be filed with this application). { FOR DEPARTMENT USE ONLY A APPLICATION ACCEPTED BY 1 DATE --�� -�_� -- ---------- ---------------------------------- -------------- ► F7` /" ---------------------------------------------------------------- DATE---------3-'------'-"----- `�, REVIEWED BY----------------------------------------------------------- - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------..............------_--------------------------------•-•------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------•--------------------------------------------------------------------------------------------------------------------------•------------------------•------------------------ f -------------------------------------------------------------------------------------------------------------------------=-------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- --------------------------------------------------------------I--------------------------------------------------------------------------------------- PERMIT No.___-96_5 ------ ISSUED---------- y/s�_____________(Date) FINAL INSPECTION BY:_____` 7___ ---------------------------------------- � Date------------ .�`---�--------------------------------------- E SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9---2M 9-50 W-1639