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APPLICATION FOR SANITATION PERMIT to -14 (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. tt JOB ADDRESS AND LOCATION------------------- J" •t� IR _ 4, rj ------------------------ Owner's Name _AXKBS _&W-A_�.T Phone O11�Q Address----------------------- � �- fJ ' -t--- -----------------------------------------------------------q------------ Contractor s Name . wR.- iteiih -------------------- Phone_--1p-=-j- �f Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 1 � Number of living units: JZ Number of bedrooms 01" Number of baths VJ Lot size----s�Q____._______ _ /101----------- Water Supply: Public systerrlorrCommunity system ❑ Privatex Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Dg 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 fr m foundation-14- -----.Materia! No. of compartments - ._Size ~� -- +' " p Capacity �, i4• ---Liquid depth_o' �t --------- 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______________________________________________ Seepage Pit: Distance to nearest well_�0�____________Distance f o fo ndation_�12_ ---------Dist Distance to nearest lot line_ Number of pifs---,/--------------- material.______________Size: Diameter__o��_ ___-____-Depth___�_Q'_________-_______ .Disposal Field: Distance from nearest well�Q_---____.Distance from foundation- _ __ _______ -X �Q Distance to nearest lot line---- Ix Number of lines---------- Length of each line---------S7_---------Width of trench______A!i Type of N filter material__ ________ _______Depth of filter material____-_____/�_____ Remodeling and/or repairing (describe)------------- ----- --------------- 'Lr`'�- .-'- ---------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ -------------- -- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,V-4- ........ es and regulations of the San Joaquin Local Health District. (Signed)___ t_ ' ~ ---------------------------------------Z Contractor) ._--- ------- ------------------------(Title)--- - h3 AQ--- - ---- --- - - ------------------------ ------ - -- - ------- - - ---------------- (Plot plans, owing size of lot, local i of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------ ----------------------------- -- DATE__ ----------------------------------------------- REVIEWED BY ------------------------------------------------------------------------ DATE--------- ----------------------------------------- BUILDING PERMIT ISSUED_______________-_ ________ DATE________-_ ----------------------------------------------------------------------------------- -------------------------------------------- Alterations and/or recommendations:________________________ - - --------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- --------------------------- ----------- -------------------------------------------------------- ---------------------- PERMIT N/ --7-4------ ISSUED---- --- ---5�— ----(Date) FINAL INSPECTION BY: Datef/ C-'77-- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California