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9 a _ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) I 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. JOB ADDRESS AND LOC TIOQy �------ ---"---- f Owner's Name--------- -- --------------------------------- Phone-=E_•�?0----- Address----- ddress------�� ------- ---- ---- -- ----- ----- - -- --- Contractor's Name I? _. _�pkF.7.C�_.. ' .ri __r 'V ,C4---------- ------------------------------------------------ Phone-----3-3.955------------- Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ® Number of bedrooms ❑ Number of baths d Lot size------------ ---l_a ___________________ Water Supply: Public system [2 Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan [}I + TYPE OF INSTALLATION AND SPECIFICATIONS: /� + [ (No septic tank or cesspool permitted if public sewer is available within.200 feet.) J4 Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- KI No. of compartments-----------P------------Capacity----B-00----------Size----4E--.x51-.-...---•-•_-_--Liquid depth-----1}2 __S'lJ'___-- Cesspool: Distance from nearest well-----------------Distance from foundation-----------------=.Lining material-------------------------------------- F-1 Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ k] Number of pits---..._X-------------Lining material.-P�_ --------Depth___ Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- � Number of lines______l_________________________Length of each line -5-Q--------------------Width of trench--------2------------------------- Type of filter material________________________Depth of filter material--- - Remodeling and/or repairing (describe___----------new...iAg:�_alj.4_j.4ij----------------------�-----� "! t � • ^� {--•----.....•'--------------------------------------------------------------------- __________________________________________________________________________________________________ ______________________________..______.____________________________________________________________________________________ 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 Local Health District. [Signed)._...........P e r. Y ---------------------------------------------------------------- -------------(Owner and/or Contractor) wner (Plot plans, showing size f lot, ocat on of system in relation to wells.buildings, etc., mustTbeefiled Owith this p�anon). FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTED BY--------- _-- _ __ DATE____/--- ' 3� REVIEWE=D BY _ Tart DATE= ---------------------------------- BUILDING PERMIT ISSUED----------------------- --------------------------- DATE---!------------------------------- ---------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------•------------------------------------------------------------------- -------------------------------------•---•---------------------------------------------------------------- ---------------------------------------- V------------ ------------_0- ; :;Z- -- - --------------------------------------•------------------------------ ----------- ---------------------------------------------------------- --------------------------------------------------------------------------------- ---------------- ------------ PERMIT No--------)`_'K-------- ISSUED___ __________(Date) FINAL INSPECTION BY:____ -- - / - Date- -•------- - - -- - --- F. ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2N1 9-50 W=1639