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s - APPLICATION FOR SANITATION PERMIT 42-10 (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w4oh described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------------ - ---- - ----- - --- - - -- - --- 1"t--------- 1---�5EA--O wner's Name------------......................... -�i%Z--------------------------------------------------------------------- PhoneA__4e0-1............. Address--------------------------------------------------' 7 � SE' � _ � --------------------------------------------------------------------------------------------------- - Contractor's Name........... -fTf-yF h?�Zt�+.�'�a----�. Q�__. -t��------------------------ Phone--V-146-Q--7------•-- Installation will serve: Residence (t Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [' Number of bedrooms Number of baths ❑ Lot ........... Water Supply: Public system ❑ Community system ❑ Privatex Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Jig, 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. .__-_-_--_--___•_-_____ ._--- No. of compartments---------------------••--Capacity-----------------------Size--------------------------------Liquid depth-- cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-______--_-._______•___-----________-. ❑ Size: Diameter-------------------------•-----------Depth--------------------------- ------------=------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.......................................... ❑ Distance to nearest lot line------------------------------------------------ e4u. lo Se pa a Pit: Distance to nearest well....�. ,1__._._.Distance from foundation-to' oundation o��_______________.Distance to nearest lot line.._.d�_-___-_--. Number of pits....... ...........Lining material !'!A-) ____Size: Diameter...jl.'...__--...Depth___�_,�_.�-._•_.....-.... Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line-_-_•____--_---__ +� !- Number of lines...................................Length of each line------------------------------Width of trench................................... Type of filter material-------------------------Depth of filter material____--.-____---....._. Remodeling and/or, repairing (describe)----------- ---------- > .................................................. . .-_./u -----1 ----------------------------------------•---------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Couniv ordinances, State laws, ru a nd regulations of the San Joaquin Local Health District. -tfnxxz�; -►'" -- ��l------ -------------• .... Contractor (Signed)..-•-- -- -1-��----- - - - - - ---- ------- ( � 6 :------ -- -----2 -------------------------------------------------------------- (Title)- �"lr�i.7x/.ta -- -------------- (Plot plan , sh win ze of lot, location of systilm in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY(- --•---•-•------------------------------------------------------------------------------ DATE - REVIEWEDBY---------------------- ----- ----------------------------------------------------------------•----•---------- DATE------z� be BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------; --••---- ---- Alterationsand/or recommendations------------------------------------------------------------------------------------------•--------------------------------------------------- -----•--•- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------................ ................---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--••- •-----------------••-•-•-•--------•-•-------------------•-----------•----•--•••----------•-•-•---••---•-•------•--•---•--•-•---•--=•-----•--•-•••-.--•-•---•-•---•-•-•---•-----•---- ------------ ------------------------------------------------------------------------------------------ ----------------------•---------------------------------------------------------------`-------------------------------••----------- PERMIT No._ 7 .t......__ ISSUED-___-C/2;.S_-_._J?�..__(Date) FINAL INSPECTION BY:../_�___W, j..--.1..1 ..................................... Date.................0 ---� ,�►- ............. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639