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411 I APPLICATION FOR SANITATION PERMIT - (Complete in Duplicate) SCANNED 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--- G �s.sl ---- --------------------------------------------------------------------------------------------- -------------------------------------------- ---------------- --- - Owner's Name___. . -� - Phone ' -- -------------------------------------- - Address.-----3---3--3---�(---------- =----------- - ------------- Contrec}or's Name_--__ _tw jl�. - -- - - --------- -------- --------- ---------- - ---- ----------- ------------------------------------------ - ------ ------ --- -- ----------------- Phone----------'- - Installation will serve: Residence Apartment House E] Commercial ElTrailer Court C] Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms W Number of baths t Lot size---.------48 -x- 1?X -- ------------------------- Wafer Supply: Public system 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.) Sep 'c Tank: Distance from nearest well.___`.--__Distance from foundation___-10�_______.Materi I.._..____ No. of compartments..__-.. _.________Capacity__-__s�C70-----Size.-_3 ..__�✓X_ Li uid de th_- _'----- J� 9 p O Cssp ol: Distance from nearest well----.___.......Distance from foundation------__--�rLining material___---__--_--___._-____---- �' Size: Diameter----------------------------------- Depth------------------------- -- - Privy: Distance from nearest well... Distance to nearest lot line____..__________.........__-_____-___-.__-___-.---____Distance from nearest building ------ -- ------------- - ------ _ _______________________________ Seepage Pit: Distance to nearest well_-.- _.____.__-__Distance from foundation------________..._.Distance to nearest lot line-------__.__-_ --El' Number of Pits----_----_---_----Lining material------ ----Size: Diameter---------------------..Depth---------------------- i o al Field: Distance from nearest well---- .__.Distance from foundation..__&_� Distance to nearest lot line.- Number of lines.--------_ -�O 2._.--.___r_- Length of each line-_-_ - --r yyidt of tranch_.._.1�__..___-__.-------- -- Type of {Iter material..._C_ ---- ---Depth of filter material-__-..__�. �� Com. �X /pp/,.YL _-___._____-_---------------------_.-____-_ -. Remodeling and/or repairing (describe):. �J 0 --- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby - certify that I have prepared this application and that the work will be done in accordance with San Joaquin C-oun-- ty ordinances, fe aws, and rules and regulations of th^San Joaquin Local Health District. (Signed) --- ----- 1f'^�- } �� -----`---`-.-----(Owner and/or Contractor) By:---------------------------------------------- (Title)- --- - - - -- - ------ ----- - ---------------- ---- - ----------------- ot plans, owing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - ----- ....---------- -------------- ----------------------- DATE- REVIEWED q�_S-0 ----------------------------- BY---------- ...... ------------ ------------- DATE 4`9-! - - - - ------- BUILDING PERMIT ISSUED.. �s 4r.,.------- ---------------------------------------------------- DATE---------- — - - Alterations and/or recommendations:----------------- ------- --------------------------------------- - - - ------------------------------------------------------------------- - - - ------------------------------------------------ ----------------------------------------------------------------- ----- ----- �Q Y if_r` ------ ---- ------------------------------ ------------------------------- ----------- -------------------------------------------------------------------------- --L ��p ' ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----'1>,"_- ix��.--�DY-$-1-bis PERMIT No------..b------.--- ISSUED-.-----D_I---1 ------------(Date) FINAL INSPECTION BY:-----------UAd_--rl-_a ---------------------------- --- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California