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APPLICATION FOR SANITATION :MIT i (Complete in Duplicate) Application is hereby made to the 'San Joaquin Local Health District for a permit to construct and instal! the work This application...is.made in compliance.with County Ordinance No. 549, herein described. JOB ADDRESS AND LOCATION._-I3o._ Btri 2 1 Joaquin , a?z hey -------- -- de__ __A19ine Md Name--------------- U -_EU-0-1-id_---- Address----------------------------32_7---� -gPhone---- 71155 ----------- �- _------------------ i -------------------------------------------------•----------------------- Contractor's Name---____-:Di-.-At P 4 0 ----- ---------------------------- Phone----- -:'8597------- Installation will serve: Residence E] Apartment House ❑ Commercial ) Trailer Court ❑ Motel4 ❑ Other ❑ i Number of living units: -E] lNumber of bedrooms ElNumber of baths n Lot Water Supply: Public system K Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay El Adob4 Hardpan [] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest I well___:�_ foundation-_,Distance from �= ___No. of compartments----------Y---------Capacity BO �7 __ -- +4 _ _+ Siz ---2 - -Liquid depth------- Cesspool: Distance from nearest well_________ DCpraPGS ❑ ________Distance from material____--_--___----_----_------____-- --------------------------------------Depth-------------------------------------------•------ � - Privy: Distance from nearest well------------------------- -----------------Distance from nearest building Distance to nearest lot line Seepage Pit:Pit: Distance to nearest ------Distance from foundation--_j- -------- Distance to nearest lot line--_ ____---- Number of pits---'_______ ________Lining material.-Circ-Cm' Diameter-___---- _ *! Depth - ----------- Disposal Field: Distance from nearest well__-_.Distance from foundation__�_i _�_r___-Dis lance to nearest lot line-__ _. RX Number of lines--I _ -----------Length of each line------ -- f- „�(ti/�'th of trench----- ------10 -----------� _. Type of filter material---L .r4 Rk Depth of filter material-----Z�-ll____ Remodeling and/or repairing (describe):__-_-_ .Pticr-__ �� gQ ��/l �i ©- . o -4'p - ---------=----- -------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- �y, = -i--------------------------------------------------------------------------------------------•----------------------------•----------------•--------------�i i 1.: I hereby certify that I have prepared this application and thafthe work will be done in accordance with San Joaquin County ordinances, State laws, and rules- nd' regulati ns of the San Joaquin Local Health District. (Signed) ' RR.rSTdr_-TNC _�_»:- ( rxp� s Contrac ------------ -- -- --------------- Contra -f ---- ------ ---- --------------------------------------------------(Title)-----91—im-for----- - (Prins, o� g siz lot, locatio' o system ' relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------'---_ -� - DATE -REVIEWED BY- -------------------------- Z ;;- � ( BUILDING PERMIT ISSUED-------------------- ----- --- - ----------- - -- DATE_DATE -------------------------- ------------- Alterations and/or recommendations:-_�--------------------------- --------------------------------------------------------------------- - PERMIT No.-_ _yG.---_--- 1SSUED/=_� ��--------------------(Date) FINAL INSPECTION BY:---- �.�/ <i.0-------------------------- Date 1 `r !' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California