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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. I JOB ADDRESS AND LOCATION------32D1__Fx,am1a_--5t---,----------_••----------------------------------------------------------------------------------•------------- Owner's Name....... --------------------------------------------------------------------------------------------------- Phone---3!n3283---------------- Address-----------32D_l..Frana±a_._St-i�-r`---------•---------------------------------------------------------------------------------------------------------------------------------------- 3 Contractor's Name------St-0- iD F.__D _ 0� "- - r_2. a fii �---Ztery-10-e Phone---3"'3955------------- Installation -----Installation will serve: Residence ® :Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1L] Number of bedrooms 121 Number of baths El Lot size-------50Ixlo-W________________________________ Wafer Supply: Public system ® Community system ❑ Private ❑ - - r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3: Hardpan ❑ f� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Ta.nk: Distance from nearest well_________________Distance from foundation--------------------Material_.._____---__---__________________._____________- ❑ •Nc.-of•compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth------------------- -- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______________________-____-________- � ❑ Size:'Diamefer--------------------------'----------Depth---------------------------------------------------- Privy: -------- ---------------------------------------- Privy: Distance from nearest well_____--------------------------------------------Distance from nearest building---_____________________________________. ❑ Distance to nearest lot line________________________________________________ ' Seepage Pit: Distance to nearest well______' ______Distance from foundation___ -__._.Distance to nearest lot line___ _ . ® --Number of pits----.____I-----------Lining material.---briak-____Size: Diameter_________4c.lr_..Dept h---17'�______________ _ Disposal Field: Distance from nearest well___" --------Distance from foundation____10__! ___Distance to nearest lot line____.? ® Number of lines_______1-----------______ l_________Length of each line__________ a __ Width of french________2;_______-_________--,: Type of filter material--r-0_Ck----------Depth of filter materia _____ _~_______ Remodeling and/or repairing (describe)----------repair-t g------ '..---- -------- ;. ----------------------------------------------------------------•............----------------------------------------------.------------------ --------------------------------------------------------------------------•--rte ----------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------•-------------------- a ------------------- I 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. 1 (Signed)........ ------------------------------------------------•----------------------------(Owner and/or Contractor) By=-----------------------------------------------------------------------------------------------------------------------------------(Title)--Q I;[l x= ---------------•-•--------- (Plot plans, showing size of lot,.location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY --------------------------------------------------- DATE e` � APPLICATION ACCEPTED BY---------------�to� ------------------------------------------------------ _REVIEWED BY----------------------------------------- ------------------------------------------------------------------------------ DATE----.----- 2r -",•� BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------- Alterationsand/or reegmmendafions-------------------------------------------------------------------------- - ---------------------•-------------------------------------------------------- -------••---------------------- •-------------------- ---Glr✓t. - --------- _ �•�• - 4 r) ____,_____________________________________________________________________________________________________.._____.._--____________________________________________-_______________ _____-_---_------_----- ---- •----- ISSUED--- 5-��-------- Date FINAL INSPECTION BY:----ll� �l --------------------------------------- PERMIT No..___�=�----------- ` � ] z 1 Date---------------- ------------------------------- SAN -------------- ----- -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California i ES-9-2M 9-50 W=1639