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APPLICATION FOR SANITATIION PERMIT n ' (Complete in Duplicate) ' vpermit to construct and install the work herein described. uin Local Health District49 a p compliance with County Ordinance No. $ & &in °arms----- Sto-kton--- application is hereby made to the San Joaq application is made in comp• >�ero This app z orner. of._�------ Zi�j.�-�&l�.Ate___-` - Phone------------- JOB ADDRESS AND LOCATION--- Qx•- --------------------------- gtreet ------------ owner's Name------------------- 1 -a`3Q• Phone. ---------------rts2rit ---- ----------------------- --------...... --- - Address-------- - rriBh Sons other our •- Motel ❑ !- Trailer Court ❑ i Commercial ❑ --..--- Contractor's Name_______________ A artment House ❑ l ?!.X1—_ Residence ❑ p dC, er of baths [� Lot size_-__.__ - installat on will serve: m f � AVAP bedrooms Number of living units: i5 stem ❑ Private ❑ Clay ❑ Adobe ] Hardpan ❑�► Community system ❑ Clay Loam❑ Y Water Supply: Public system Gravel ❑ Sandy Loam y Character of soil to a depth of 3 feet: Sand [] -TYPE OF INSTALLATION AICD SPECIFICATIONS: kll� ----------.Material.-----C'- --��---BrIoX--------------- public sewer is available within 200 feet) ., rmitted°if p i (No septic tank or cesspool pe �j -Liquid depth_?------------ .Distance from foundation_Sb"� �-------------- Z.040 Q ze ...---- -- Distance from nearest well_��Q�__-'_Capacity_-- -'--'"--"•- Septic Tank: --� material------------------------- g No. of compartments___- _- • nc ---- __ Distance from nearest well_________,.____-__Distpance from foundation_,----- rest building - _De t ---- Cesspool• g---------------- --- 0 Size.,Diameter___._.___. Distance from nearest Distance from nearest well. t Privy: _ .Distance to nearest lot, line ------------•-- Distance to nearest lot line__-._---- Q - ___--_ _ � ._ ❑ ],�,Q __---Distance from foundation ------------.Depth_O.. 'Seepage Pit: Distance to nearest well--•- Lining mater ia.+ ... D-t-Size: Diameter Number of pits..__ from foundation__._�!------Distance to nearest Ian®-•�'4 Distance do Width of trench-------- ---------- Disposal Field: Distance from nearest well �,0--`:_ Length of each line a Number of lines-----------i__ M _1 2 unit a-------------- _ k__;-De Depth of filter material--------------- p COLIY't•• Type of filter material_._1 - rt'�ent --------------------- r - -1 ---- et start ---------------------------------------------------� describe) DLA .3.X1 6d. Remodeling and/or repairing ( ... • �u1uxe $..omits---not_._Y---------------------------- Q g1'et_�.Qx�, njaar1 a.P-- - - ------------------------------------------------•-------- - - uin County --------------------- r ---- -------------------- -----------------------------------"----"-------�--�--�- -- application and that the ' HelaltheDistrict. accordance with San caq ---------- re ared this app I hereby certify that I have P p ulations of the San Joaquin Loc ( Contractor) ordinances, ate laws, and rules a d reg . ......... ----(tris)-----�eti�V&tar--------- ----------- (Signed).-_k ? application). By oration of stem in relation to wells, buildings, etc.;must be filed with is (Plot plans,s wing size of lot,I FOR DEPARTMENT USE ONLY DATE------ff/j--- - DATE-------------- BY ------ -� APPLICATtON ACCEPTED BY------------- DATE---------- ------_------ REVIEWED BY--------------------- --- ISSUED BUILDING PERMIT recommendations--------------------------'-------- Alterations and/ ------------------------------------••--• ---- .. ---------------------------------------- ----- ------------------------------------------- ------------------------ -- --- ..... 22 �S_�__-._..__--(Date) FINAL INSPECTION B - 2_11SJ -- - --- ISSUED_..---------------- ------- CC ._ Date No.____�-9----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES_9_21,4 9-50 W=1639