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APPLICATION FOR SANITATION PERMIT 42-11 (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 LO TION no---13.�L''` -------- ------ Owner's Name-------------------------�--- '---- ---- M--n.... Phone Address------------------------------1-l---------------dt----joro------------------------------------------------------------------------------•------- ------------•-------------------------------- Contractor's Name-------------------QLM.A-A..------------------------------------------------------------------------------------------- -- Phone--------`- Installation will serve: Residence Vq Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: © Number of bedrooms ; Number of baths m Lot size_-_--___-.60..1c._ D!......................... Water 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-9F-Hd TALLATION-AMD-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well....6.0......Distance from foundation-----IP----------Material..... ................... No. of compartments__-__-_---Z*........_---Capacity_... g�j_..Size �A� -------Liquid depth.......#4-__-_ Cesspool: Distance from nearest well----------_------Distance from foundation______ __________.Lining material---- -_ -------.__1............... ❑ Size: Diameter------ ----------------------------Depth.------------------ ------------------------- Privy: Distance from nearest well.....................•__---__-_--__.----___-__.._Distance from nearest building _____-_- _-----❑ Distance to nearest lot line.........-------------_--------------------- j Distance to nearest ----- ! Distance from fou -------.Distance to nearest lot line_._,20...... N / Num ....... - mg ma er' .__ tSize: Diameter..__.. " Disposal Field: Distance from nearest well....X. ___.Distance from foundation_--. -_.Distance to nearest lot line 7..AjO..... Number of lines..•.•....._.&"'.-_�..._-_•••__-Length of each line-.-I&A .-_' O:..Width of trench--------A.................... :.. Type of filter material_.lx..' "re*_kDepth of mater4hl .......11.....--.. Remodeling and/or repairing (describe)--------Ar-E.W-------1,0_1--- --------•------------------------- ---•------------------------- ------ -------------------------------------------------------------------------------•--------------- -------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------W----------'4 ------------------ -----------------------------------------------•-------------•------------------------------------------ I hereby certify that I have prepared this pplication and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rule and reg tions of the San Joaquin Local Health District. ....... S.4-----4 ------- -- ---- --------------- ---- ------ ---••- ----------.......... -----------(Owner and/or Contractor).' (Signed) By:---------- tom---�"' "` -- ---- -- -----------------------------------_ (Title)------�------ ---- - -----•------- (Plot plans, showing size of lot,lo-ca ion of system in relation to wells, buildings, etc., must be filed with this application).` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED. BY------------------ -.1� i5 - DATE , ..'-I'1 �- --- ---------------------------- REVIEWEDBY-----------------------------------------------------i�--------•------------------------------- ---------------- DATE---------- = ''��---------_---------------- BUILDINGPERMIT ISSUED-------•---------------------------......................------------------_-----------............ DATE----------------------------------------------------------- Alterationsand/or recommendations:.....................................................................................................................................--------------•----------- ----•--------------------------------------•---•----------------------------------•-------------------•----------.------•-------............................................................-.............................. -----------------------------------------------------------------------••--•-------•----•--•-----•-------------•----------------------------•-......-------------------------------------------------------- _- ---- --------------•----------------------•-----•------••--•------------------------------------------------------------------------------•--------------------------------------------------------------------- -------------- ------------------------------------ ---------------......................-.......-.................•-............-------------------------•------------------------------------------------------------------------------- PERMIT No-31-1. ----------- ISSUED-R.. /6__-_ __ ____________(Date) FINAL INSPECTION BY:......._Uj-_v----l..`!_-___,_..___---•--_--.----•------ Date................... -......'�--"..... ---------•------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639