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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) made to the San Joaquin Local Health District fora permit to construct and install the work herein described. Application is hereby q This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCATION_________ Phone-4./-'z::> Owner'sOwner s Name------ (J 616 51•-------3=`�--- � ------------ - e Address_ . -- --f------------ rt - --. ----- _ SgivContractor's Name-------- 1�-'�---�---------- F -1 t`` 7 --- �t-- L� � Phone Installation will serve: Residence ' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living uni��s: '❑ Number of bedrooms Q rNumber of baths ❑ Lot size______________________-___-_____________________.__--_- Water Supply: Public systemCommunity system ❑'-Private;❑ - Character of soil to a depth 0 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adob ek Hardpan❑ fi TYPE OF INSTALLATION AND SPECIFICATIONS':- (No PECIFICATIONS:(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distanced from nearest well i------------Distance from x ` , II rfoundation_______________Y.Material________--------______-____ ❑ KSMANo. of compartments--------------------------Ca Capacity-- -------------=-----------Liquid depth----------------------- .1 ------ .- ; ---. Cesspool: Distance .from nearest well_________________Distance from' rom foundation___________ Lining material------------------------------ r ❑ Size: Diameter----------------- - =- -----Depth-----;------------ ------=------------------------ '___Distance from'nearest budding { Privy: Distance from nearest well = =-----------=-=--=----------' -- g - #' 1 - ` Distance to nearest lot line--------"__�_ ----------------- Distance - w � rom o dation. _ ________.D�stance to nearest Iqt line__- __- Seepage Pit: Distance to p Barest well___t VO —�_ Dist e,, F fi . r .� Number of its- �y_" -----Linin mat r:al___aaZ;Ll_�--- ize: Diameter__-.-.� y______----.Depth-. ----k�-------------------- ' Disposal Field: Distance from nearest well__ _____Dista e from fo anon-_ _,_ _ _Distance to nearest lot line--ff ��e�- f Number of lines__ / _' ___ __ _Len th o eac line .''* Width of french _�r__________ a g rrr" a*---------r_ Type of(Iter materially _rjA�J _Depth of filter ----------- 'Remodelingmaterial and/or re airing (describe) ,:- ------------ ---------- -------- �' i: = v r --------------------------- F / p - '- ��1 1 i__ :�'1. �' z�J .- -� fj ---�------------------------ - ------------ -- ---- ---------- ----- =' ;j r- --- --I hereby certify that I -------------------------------- -------------------------------------------------------------------:----------=------------------------------ ---------------------- have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Star ws, and r Ii and' Tgulations of the San Joaquirr'L'ocal Health District. i � = K- ` -Pk ----- _- --(Owner and/or ntractor(Signed)-- ---4 By'- y�� + - 1'%-" ��' ' (Title ---------• ------------------z o I(Plot plans, showing s e-location of system in relation to buildings, etc., must be filed with` his application). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- J�_ -y-- ------'---=-------------- -------- - DATE------------' -t -------------------------------------- REVIEWED -- -------- -------- REVIEWED BY------------------- _------------------------ r *+ DATE -= = ---------- ----------------------------------------------- r r ;Of BUILDINGPERMIT ISSUED------------------------------------------------- ------- --------------------- --------------------- DATE-------------------------------------------------------- Alterationsand/or recommendations----------------------------------------------------------------------------------------------------------------- �----------------------------------------- II � -------------------------------------------- -------------------------------------------•-------------------------------------------- ------------------------- - ------ --------------------------------------------------------------------------------------------------- ------ 11-------- --------------- ---------------------------- ----------------------------------------------------------------- -------------------- --------------- ------------------------------ ts PERMIT Nol�-4-------"ISSUE1 71 -------(Date) FINAL INSPECTION BY:----------- - -- __-- -----�� -------------- Date----- ---------------------- ---=-'--- --�------,j') --------------- li :! SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton; California HS q-2M 9-50 W-1639