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Z ( 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. ' - ----------------- JOB ADDRESS AND LOCATION----��,_/_'_____ ._'_,/�_T_a3�___�_i__.__�:_L'__!4C._�_J_9__.__-.__�a��'Q_!'�!____ __ . Owner's Name-------------------11Wn d 2Zd------ --- ----------------------------------------------------- Address ------- ---------------------------------------- Phone: _ Address--------------------------------- - ,/� t (�-•----•�'�''�1f''7�`-----�----------��---�-�=�--�r-H--S:r'L'�-G! �--`----------•---------------------------•---- •----------------- Contractor's Name __[�f-• a[2.RS_h►_at-c3tc_t t'-- 1_C------------------------------------------------------------ Phone-- 9=__�___Ie_j0•7-------- Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [ ] Number of bedrooms [2} Number of baths ® Lot size----- J?x_-_ -----.AY* _0_______________ Water Supply: Public system JZ Community system ❑ Private ❑ ® _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe„$ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_______________Distance from foundation---------------------Material----------------------------- --------- ❑ No. of compartments------------ ------------Capacity----------------------Size--------_--_----------------..Liquid depth--------- -- Cesspool: Distance from nearest well__-.____-_ -Distance from foundation___________________ Lining material_._ _______._ ____,_....... ❑ Size: Diameter----- ------------------------_-Depth---------------------------------------------------- -Privy: ------ ----`Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------_ ___-,_--_ __...-:_............ ❑ Distance to nearest lot line------------------------------------------------ Seepage _____________•---_--- -----------------__--__Seepage Pit: Distance to nearest well•---------------------Distance from foundation--------------------Distance to nearest lot line-------------- _.- ❑ Number of pits_________________ ___Lining material•_---_ -___•----- Diameter------------------------Depth --.--_ -_. Disposal Field: Distance from nearest well-AA-0--,Distance from foundation Distance to nearest lot line .I Number of lines.-_ /__ .-- _--_Length of each line .O � __.__Width of trench...... _ "............ 9 Type of filter matenaLl k-_lt�k.._M.Depth of filter material_.1��..! .-�r�'tJ. `Remodeling and/or repairing (describe):-------- �� - 21? E/�T[' -f.Z--•• ,fix ....s -�m ------------------------------------------------------------------•----------------------------------------------------------• --------------------•-------------•-'-------------------------------------------------- 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, nd rules and regulations of the San Joaquin Local Health District. (Signed ( 1 s �-1-- - --- -----M-1-I's........ �--------------------- Contractor) B ------ - ------- -- ----- ----• - ------ ----------------------------------------------- --•-- Title------ !'� --------- ( ) -�.�: (Plot ans, sh i 'u`e of lot, location of stem in r aon to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________________________- -�-- DATE_ S -- -- �-- -----_ DATE ----3 REVIEWED BY----------------------------------------------------...----_._•.----------- ._-..---------------- --------- ---------------- BUILDINGPERMIT ISSUED---------------------------------------------------•--•-----------------------------------------•- DATE------•--------------•------------------------------------ Alterationsand/or recommendations:.-_------------------------------------------------------------------------------------------------------------------•-----------------------------------• 1 11 PERMIT No.....t}a, ....... ISSUED....... _-_ --.(Date) FINAL INSPECTION BY:......`MVV----[,_.......___________•_-___._. Date 3. -- -e'=- 1-----------_-----------•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street - Stockton, California ES-9-2M 9-50 W=1639