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APPLICATION FOR SANITATION PERMIT60 t (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. JOB ADDRESS AND .LOCATION-----------2049--- -ls--------------------------- Owner's Name--------- -------------------------------------------------------------- -------------------------------------- ' Phone---3-- 519------- Adrress----------------------1��---Hiawatha-------------------------- - - - --- -------------------------------- ------------------------------ - -. — --------------- -------- � - � ----- Contractor's Name. ----------- Ins+afa+ion will serve: Residence ) Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: •[X. Number of bedrooms Ea' Number of baths M Lot size_____.2_5X---2.5fl___________________________________ Water Supply: Public system EX Community system ❑ Private ❑ iy;) Character`of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe❑K Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i tank or cesspool permitted if public sewer is available within 200 feet.) (No septic p p Septic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material------------------------------------------------- f ' ` No. of compartments--------------------------Caacit -----------------------Size-------------------------- qdepth Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-_______________---_'_____ ________', ❑ i - Size: Diameter-----------------•---------- ---Depth-------------- -------------------- - .-.., � Privy: = Distance from nearest well_________________--__________________-___-_----Distance from nearest building_______---- ____________ _ _ "v. _ -----_.. Distance to nearest lot line-------------------_---------------------------- Seepage _____ _ __See a e Pit: Distance to nearest well--------10f}------Distance from .foundation____-- ____.Distance to nearest lot line------ tl Number of pits-------1------------Lining material---bx-ick-__--Size: Diameter-----4�---------------Depth---2 __---_--------____-- ..Disposal Field: Distance from nearest well---------------- .Distance from foundation_________- _______Di0ance to nearest lot-line______----------- tt Number of.lines------------ Length of each line-----------n!P---------.Width. of +rench------------------------------ Type of filter material-------------------------Depth of filter material-------------- -------- a R un---to t L Remodeling and/or repairing (descrfbeJ:__ -___�].15��,11i�7.�__YL�3r�___fez't�.��.l--d�-�.i�1---�p.�---7�o�i�1.t�-- II i _exxzt-ng---aept_i.c--- al kh Frith_-�---solid-_1 .ae------------------------------------------------------------------------------------------------------------ s :-------------- -------------------------------------------------------- -------------- ------------ ------------------------------------------- I hereby certify that I have;Aprepared 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 Loca ealth District. (Signed)-------DO-1ta-- ----- s- _ - -------- ------- ------------------------------(Owner and/or Contractor) [ BY:--------- es'z'Y-ar It Y T-'r� ::: -----'---------(Title)-------0wner__h_e;r_A---------------------------- (Plot ---------- ------Plot plans, showing.size of lot, loc 'ion of s e r a+ion t ells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -------- -- --- -- - ---'- -- -- .------ DATE----,-._-- . 7_-�_ ------------------------------- {r ,- - ; REVIEWED BY--------------- -"=;,--- --------- --------------- ---- ----- -----------------------.-.----- DATE - 1. iBUILDING PERMIT ISSUEQn-----------4---------------------------------------------------------------------------------------- DATE--------------------------------------------------------------- Alterationsand/or recommendation`s:------------------- ------------- ---------------------------------------------------------------------------------------------------------------------------- - - ----------------------------------------------------------------------- ----------------------------------------------------------------- -------- ------------------------------------ ------------- ---------- - ----- -- --------------------- ---------------------------------------------------------------- -- ------------------------------------------------------------ -------------------------- 6 PERMIT No. 4 --.------ ISSUED___ ------(Date) FINAL-INSPECTION BY:---------vv---�---- --------------------------------- --- ;�. .-- Rafe---------------------� --~- ------�---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ' E5-9-2M 9-50 WA639 a