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6 3 ey� A� APPLICATION FOR SANITATION PERMIT Ab� V .(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------,* --Z.--22-mon'b_-Street-------------------------------- - ----------- , -------------- Owner's Name-------------- ---------- � ------- ------- --------- -------- Phone-3—M-2------------------- _ Address----------------------------------------------------4= _R- -- -o'A- ---S ae Contractor's Name----------------------------=---H'---A-'--FJUMSH & _S0NSr--- PN ------------------------------------------------ Phone--- 9--96-07---------------- installation will serve: Residence Zr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:, Slumber of bedrooms M Number of baths 11 Lot --------------------- f Water Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [I. Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se;v�is available within 204 feet.] Septic Tank: Distance from nearest well_____35-t___pP_---L Distance from foundation____I��__------Material_____f`s___C__11riek---------------------- 56!31*�6 "-----Liquid depth----52*------------- No. of compartments------ -2----------- Capacity----�--�- Size-------- ----------- Cesspool: F Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------___..__________-. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- -Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from. foundation-------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------ ----.Depth-------------------- ----------- Disposal Field: Distance from nearest well___�_+_�T--------Distance from foundation----A91--------Distance to nearest lot line____5 -- Number of lines____________�--------------------Length of each line------IdQ�______-__---Width of french-------- __- - - Type of filter material--1 __Rk--------Depth of filter material-----1 __________ Remodeling. and/or repairing (describe)--------gew--Jns--ta.Uation--I-eplacing--Er--8ti73g--d8 3Ct--,s7,S -------------------'. - ----------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ------ 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 rule and' regulations of a San Joaquin Local Health.District. r D. A, P I & NS' �'='' ----- ..-_.. - -------------- �' ------------------[ 'Ci i 6 Contracts;l Si sed ------------ ----- ( 9 - By:. - --------- --------------------------------------(Title)-----T`'-5tim __----------------------------------- =- ---------------------`--- -- -- --- (Plot plans, sho in size of lot, location of system in ation wells, buildings, etc., must be filed with this application). { F R DEP RTMENT USE ONLY APPLICATION ACCEPTED BY - ------------------------------------- DATE f----------------------------- --- DATES = C '" -------------- REVIEWED BY------------------------------ - l� _;;; /y /o BUILDING PERMIT ISSUED--------1------"`--- --- ,..-- DATE Alterations and/or recommendations:-------------------------------------- ---------- ----------- ----------------------------------------------------------------------------------------------- ---------------------------------------- --------------------------------------------------------- -. -------------------------- -------------------------------------------------------------------------------------------------------------------- - -------------- ----------=------- PERMIT No.____�-_ --- ISSUED--- _---------------{Da -------- (Date) FINAL INSPECTION BY: --, ----- -------------------------------------- �-- t Date-------------------I------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-21A 9-50 W=1639