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#II to .. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District 49 a permit to construct and install the work herein described. This application is made in compliance with County Ordinance JOB ADDRESS AND LOCATION - R 7 L. Phone----------- -------------- Owner's Name------------------------------------ ----------------------- �ST^f-- r- Phone Address e/'L --------------------------- -Contractor's Name---------- --- -- -----.�-- ------- �' Installation will serve: Residence [9/ Apartment House El Commercial ❑ Trailer Court E] Motel [I Other El Number of living units: Number of bedrooms Number of baths Lot size-------------------- Water Supply: Public system Community system ❑ Private ❑ Loam ClAdobe['Hardpan [ Character of soil to a depth of 3 feet: Sand El Gravel E] Cla Sandy Loam ❑ Y ❑ Y TYPE OF INSTALLATION AND SPECIFICATIONS: 100- No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic ank: Distance from nearest well-----------------Distance from foundation__________-_______.Materia!____`Sr�'�-------- -----Ca acit -Size--------------------------------Liquid depth-------------------------- �. No. of compartments------------------- Capacity ------- --------- Cesspool: Distance from nearest well________________Distance from foundation------------------ Lining materia ------------- ❑ Size: Diameter-------------------------- -----------Dept ---------------------------------------------------- Privy: --- --------- ------ --------- ---- - --------- Privy: Distance from nearest well -------------------------------------------------Distance from nearest building ------------------------------------------ 171 ---------------------❑ Distance to nearest lot line------------- ------------------------------- - / Seepa Pit: Distance to nearest well-_X00 Distance to nearest loIe----------------- - ------- ------- --------- 3 - _ DP b� t� ---5'ze: Diameter__ _3 Number of pits-------/------------Lning material___ io Disposal Field: Distance from nearest well------ /---Distance from foundation__._ ___-- --Distance to nearest lot line_______________ `r y Number of lines_______________ ` -- WT-Len th of each line___--________ _----- ----Width of french___--____-. _------__-_-- Type of filter materiaL__� _- pth of filter material_______:_ll _---_._. Remodeling and/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ------------------------------------------- --------- y y - - - ------------------- ----------- -- - ' I hereby certify that I have prepared this application and }ha} }he work will be done in accordance with San Joaquin County ordinances, State laws and ulgs-an lations of the S nein Local Health District. Contractor) Signed ! /2i h� -- C _C__ (� -- --- - -- - - - - - - - - ( • }-------- - � _ --(Title- -- - -�'CJ_'�� ---Q"J----------------------- B ------ ------- -- �- - (Plot an owing size of lot, location of s stem in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY DATE------------ / ---------------- APPLICATION ACCEPTED BY------------------ - - - - DATE---------- -------- ------------------------------------ REVIEWED ---- ---------- ------------ -------------------- REVIEWED BY---- -------- -------- ------- --------- - ---------------------------------------------------------- -- -------------------------------------------------- --- --- -------- ----- DATE --------- ------- ------ - ---------- --------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ---------------------- - - ------------------------- -------------------------------------------------------------------------------------------------------------- Alterations and/or recommendations:---------------------__ __------- -------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- PERMI7 N .?C1� Date FINAL INSPECTION BY:_____-_ ___ ---------- ISSUED I t }� Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W_?639